Timing of vasopressor initiation and mortality in septic shock: a cohort study

摘要: Introduction: Despite recent advances in the management of septic shock, mortality remains unacceptably high. Earlier initiation key therapies including appropriate antimicrobials and fluid resuscitation appears to reduce this condition. This study examined whether early vasopressor therapy is associated with improved survival therapy-refractory shock. Methods: Utilizing a well-established database, relevant information duration time administration following initial documentation recurrent/persistent hypotension shock was assessed 8,670 adult patients from 28 ICUs Canada, United States America, Saudi Arabia. The primary endpoint hospital discharge. Secondary endpoints were length ICU stay as well ventilator support dependence. Analysis involved multivariate linear logistic regression analysis. Results: In total, 8,640 met definition vasopressor/inotropic documented. Of these, 6,514 suitable for overall unadjusted rate 53%. Independent correlates included liver failure (odds ratio (OR) 3.46, 95% confidence interval (CI), 2.67 4.48), metastatic cancer (OR 1.63, CI, 1.32 2.01), AIDS 1.91, 1.29 2.49), hematologic malignancy 1.88, 1.46 2.41), neutropenia 1.78, 1.27 2.49) chronic hypertension 0.62 0.52 0.73). Delay antimicrobial 1.07/hr, 1.06 1.08), age 1.03/yr, 1.02 1.03), Acute Physiology Chronic Health Evaluation (APACHE) II Score 1.11/point, 1.10 1.12) also found be significant independent mortality. After adjustment, only weak correlation between delay (adjusted OR 1.02/hr, CI 1.01 1.03, P 14.1 hours). There no relationship (P = 0.313) trend longer 0.055) among survivors. Conclusion: Marked delays are small increase risk