Delayed vasopressor initiation is associated with increased mortality in patients with septic shock. Journal Article

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Authors: Colon Hidalgo, D; Patel, J; Masic, D; Park, D; Rech, MA
Article Title: Delayed vasopressor initiation is associated with increased mortality in patients with septic shock.
Abstract: PURPOSE: Mortality rate for septic shock, despite advancements in knowledge and treatment, remains high. Treatment includes administration of broad-spectrum antibiotics and stabilization of the mean arterial pressure (MAP) with intravenous fluid resuscitation. Fluid-refractory shock warrants vasopressor initiation. There is a paucity of evidence regarding the timing of vasopressor initiation and its effect on patient outcomes. MATERIALS AND METHODS: This retrospective, single-centered, cohort study included patients with septic shock from January 2017 to July 2017. Time from initial hypotension to vasopressor initiation was measured for each patient. The primary outcome was 30-day mortality. RESULTS: Of 530 patients screened,119 patients were included. There were no differences in baseline patient characteristics. Thirty-day mortality was higher in patients who received vasopressors after 6?h (51.1% vs 25%, p?.01). Patients who received vasopressors within the first 6?h had more vasopressor-free hours at 72?h (34.5?h vs 13.1, p?=?.03) and shorter time to MAP of 65?mmHg (1.5?h vs 3.0, p?.01). CONCLUSION: Vasopressor initiation after 6?h from shock recognition is associated with a significant increase in 30-day mortality. Vasopressor administration within 6?h was associated with shorter time to achievement of MAP goals and higher vasopressor-free hours within the first 72?h.
Journal Title: Journal of critical care
ISSN: 1557-8615; 0883-9441
Publisher: Elsevier Inc  
Date Published: 2019