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Advisor(s)
Abstract(s)
Introdução: O choque séptico é uma causa significativa de morbi-mortalidade globalmente. A noradrenalina é unanimente considerada como o vasopressor de primeira linha, e a vasopressina é o agente de segunda linha recomendado. No entanto, ainda existem incertezas quanto à eficácia, timing e segurança da vasopressina.
Objetivo: Determinar se a combinação de vasopressina à noradrenalina em pacientes com choque séptico está associada a diferenças na evolução dos parâmetros hemodinâmicos e metabólicos, na necessidade de suporte orgânico, mortalidade e eventos adversos.
Métodos: Este estudo retrospetivo unicêntrico avaliou pacientes admitidos na UCI Polivalente do Hospital Garcia de Orta entre Outubro de 2022 e Outubro de 2023 com choque séptico tratados com noradrenalina, com ou sem adição de vasopressina. Foram avaliados os parâmetros hemodinâmicos e metabólicos nas primeiras 24 horas, mortalidade e necessidade de suporte orgânico. Foram efetuadas análises de subgrupos para a resposta à vasopressina e para doses de noradrenalina superiores ou inferiores a 0,5 μg/kg/min.
Resultados: A perfusão de vasopressina reduziu as necessidades de noradrenalina em 25 % nas primeiras 8 a 12 horas e em 54,5% ao longo das primeiras 24 horas (P=0,006 and P=0,002, respetivamente) e também diminuiu a frequência cardíaca nas primeiras 8 a 12 horas e durante as primeiras 24 horas (P=0,015 and P=0,013, respetivamente). A resposta à vasopressina associou-se a uma diminuição da frequência cardíaca (P=0,004 para 8 a 12 horas; P=0,031 para as 18 a 24 horas). O uso de vasopressina não se associou a um aumento da incidência dos eventos adversos nem a diferenças na mortalidade.
Conclusão: A perfusão de vasopressina reduziu as necessidades de noradrenalina e a frequência cardíaca, mas não se associou a diferenças na mortalidade e eventos adversos.
Background: Septic shock is a significant cause of morbidity and mortality worldwide. Norepinephrine is unanimously considered as the first-line vasopressor, and vasopressin is recommended as the second-line agent. However, there are still some uncertainties as to vasopressin’s efficacy, timing and safety. Aim: This study aims to determine whether vasopressin combination with norepinephrine in patients with septic shock is associated with differences in the evolution of hemodynamic and metabolic parameters, the need for organ support, mortality outcomes and adverse events. Methods: This single-center retrospective study evaluated patients admitted to the Polyvalent ICU of Hospital Garcia de Orta between October 2022 and October 2023 with septic shock treated with norepinephrine, with or without addition of vasopressin. Patients’ hemodynamic and metabolic parameters in the first 24 hours were evaluated, as well as mortality outcomes and organ support needs. Subgroup analyses were pursued for vasopressin response and norepinephrine doses above and under 0,5 μg/kg/min. Results: Vasopressin perfusion reduced norepinephrine requirements by 25% in the first 8 to 12 hours and by 54,5% throughout the first 24 hours (P=0,006 and P=0,002, respectively), and also decreased the heart rate in the first 8 to 12 hours and during the first 24 hours (P=0,015 and P=0,013, respectively). Vasopressin response was associated with a decrease in heart rate (P=0,004 for 8 to 12 hours; P=0,031 for 18 to 24 hours). Vasopressin use was not associated with an increase in adverse events nor differences in mortality outcomes. Conclusions: Vasopressin perfusion reduced norepinephrine requirements and heart rate but was not associated with differences in mortality and adverse events.
Background: Septic shock is a significant cause of morbidity and mortality worldwide. Norepinephrine is unanimously considered as the first-line vasopressor, and vasopressin is recommended as the second-line agent. However, there are still some uncertainties as to vasopressin’s efficacy, timing and safety. Aim: This study aims to determine whether vasopressin combination with norepinephrine in patients with septic shock is associated with differences in the evolution of hemodynamic and metabolic parameters, the need for organ support, mortality outcomes and adverse events. Methods: This single-center retrospective study evaluated patients admitted to the Polyvalent ICU of Hospital Garcia de Orta between October 2022 and October 2023 with septic shock treated with norepinephrine, with or without addition of vasopressin. Patients’ hemodynamic and metabolic parameters in the first 24 hours were evaluated, as well as mortality outcomes and organ support needs. Subgroup analyses were pursued for vasopressin response and norepinephrine doses above and under 0,5 μg/kg/min. Results: Vasopressin perfusion reduced norepinephrine requirements by 25% in the first 8 to 12 hours and by 54,5% throughout the first 24 hours (P=0,006 and P=0,002, respectively), and also decreased the heart rate in the first 8 to 12 hours and during the first 24 hours (P=0,015 and P=0,013, respectively). Vasopressin response was associated with a decrease in heart rate (P=0,004 for 8 to 12 hours; P=0,031 for 18 to 24 hours). Vasopressin use was not associated with an increase in adverse events nor differences in mortality outcomes. Conclusions: Vasopressin perfusion reduced norepinephrine requirements and heart rate but was not associated with differences in mortality and adverse events.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Keywords
Choque séptico Vasopressina Noradrenalina