title: Impact of Norepinephrine Weight-Based Dosing Compared With Non-Weight-Based Dosing in Achieving Time to Goal Mean Arterial Pressure in Obese Patients With Septic Shock.
abstract: BACKGROUND
  Currently, a lack of standardization exists in norepinephrine dosing units, the first-line vasopressor for septic shock. Timely achievement of goal mean arterial pressure (MAP) is dependent on optimal vasopressor dosing.
  
  
  OBJECTIVE
  To determine if weight-based dosing (WBD) of norepinephrine leads to earlier time to goal MAP compared with non-WBD in obese patients with septic shock.
  
  
  METHODS
  This was a retrospective, multicenter cohort study. Patients had a body mass index (BMI) ≥30 kg/m2and received norepinephrine for septic shock with either a non-WBD strategy (between December 2009 and January 2013) or WBD strategy (between January 2013 and December 2015). The primary outcome was time to goal MAP. Secondary outcomes were norepinephrine duration, dose requirements, and development of treatment-related complications.
  
  
  RESULTS
  A total of 287 patients were included (WBD 144; non-WBD 143). There was no difference in median time to goal MAP (WBD 58 minutes, interquartile range [IQR] = 16.8-118.5, vs non-WBD 60 minutes, IQR = 17.5-193.5; P = 0.28). However, there was a difference in median cumulative norepinephrine dose (WBD 12.6 mg, IQR = 4.9-45.9, vs non-WBD 10.5 mg, IQR = 3.9-25.6; P = 0.04) and time to norepinephrine discontinuation (WBD 33 hours, IQR = 15-69, vs non-WBD 27 hours, IQR = 12-51; P = 0.03). There was no difference in rates of atrial fibrillation (WBD 15.3% vs non-WBD 23.7%; P = 0.07) or mortality (WBD 23.6% vs non-WBD 23.1%; P = 0.92).
  
  
  CONCLUSIONS
  WBD of norepinephrine does not achieve time to goal MAP earlier in obese patients with septic shock. However, WBD may lead to higher norepinephrine cumulative dose requirements and prolonged time until norepinephrine discontinuation.
authors.affiliation: 1 University Medical Center Brackenridge, Austin, TX, USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Vadiei
authors.affiliation: 1 University Medical Center Brackenridge, Austin, TX, USA.
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Daley
authors.affiliation: 2 Seton Medical Center Williamson, Round Rock, TX, USA.
authors.forename: Manasa S
authors.initials: MS
authors.lastname: Murthy
authors.affiliation: 1 University Medical Center Brackenridge, Austin, TX, USA.
authors.forename: Carrie S
authors.initials: CS
authors.lastname: Shuman
mesh_terms: D000368:Aged; D062186:Arterial Pressure / Q000187:drug effects*; D001835:Body Weight; D054796:Drug Dosage Calculations; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D009765:Obesity / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D012772:Shock, Septic / Q000150:complications / Q000188:drug therapy*; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D009638:Norepinephrine
keywords: dosing; mean arterial pressure; norepinephrine; obese; resuscitation; septic shock; vasopressors