| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 363.94 KB | Adobe PDF |
Advisor(s)
Abstract(s)
Introdução: A mortalidade por choque séptico refratário é muito elevada e a melhor gestão da terapêutica vasopressora ainda não é consensual. As recomendações atuais não estabelecem um limite superior para a dose de noradrenalina utilizada, sendo clinicamente difícil estabelecer o ponto de ausência de benefício terapêutico. Pretendemos caracterizar a utilização de noradrenalina no choque séptico e avaliar a mortalidade e efeitos adversos associados.
Métodos: Estudo retrospetivo com todos os doentes admitidos por choque séptico numa Unidade de Cuidados Intensivos durante o ano de 2018. Análise estatística descritiva dos dados recolhidos com testes não paramétricos, bem como análise de regressão, quando adequado. A significância estatística foi definida para um p value < 0,05.
Resultados: Na nossa coorte de 173 doentes, a mortalidade global foi 43,9%, chegando a 78,7% nos doentes que fizeram noradrenalina > 2,0 μg/kg/min, um valor menor do que previamente descrito. Em todos os subgrupos de doentes, a dose máxima de noradrenalina foi utilizada tendencialmente nas primeiras 48 horas de internamento. No grupo de doentes que fez noradrenalina > 2,0 μg/kg/min, a dose inicial foi 1,6 ± 1,3 μg/kg/min, a dose máxima foi 3,5 ± 1,2 μg/kg/min, e a duração da dose máxima foi 5,9 ± 4,4 horas. Houve uma correlação positiva entre a dose máxima de noradrenalina necessária e a ocorrência de isquémia digital (p = 0,01), isquémia intestinal (p = 0,02) e decisões de limitação terapêutica (p < 0,01).
Conclusões: Apesar de o choque séptico permanecer uma entidade com mortalidade muito elevada, a utilização de noradrenalina de alta dose, mesmo quando superior a 2,0 μg/kg/min, parece ser clinicamente útil para reverter um quadro de choque séptico refratário, quando empregue por curtos períodos de tempo na fase inicial do mesmo. A necessidade de utilizar noradrenalina de alta dose relaciona-se com o aumento da frequência de complicações isquémicas e com a probabilidade de decisões de limitação terapêutica.
Introduction: Refractory septic shock is associated with very high mortality and the vasopressor management isn’t yet consensual. Current recommendations do not define a maximum noradrenaline dose; therefore it is clinically difficult to establish the point of no therapeutic value. We intend to characterize noradrenaline use in septic shock and evaluate mortality and adverse effects associated with it. Methods: Retrospective analysis from all patients admitted to an Intensive Care Unit with a diagnosis of septic shock during the year 2018. Descriptive statistical analysis using non-parametric tests, as well as regression analysis, when adequate. Significance was defined as a p value < 0,05. Results: In our cohort of 173 patients, global mortality was 43,9%, reaching 78,7% in the subgroup of patients who received noradrenaline > 2,0 μg/kg/min, less than previously reported. In all patient subgroups, maximum noradrenaline dose was predominantly used during the first 48 hours after admission. In the subgroup of patients who received noradrenaline > 2,0 μg/kg/min, initial dose was 1,6 ± 1,3 μg/kg/min, maximum dose was 3,5 ± 1,2 μg/kg/min, and maximum dose duration was 5,9 ± 4,4 hours. There was an association between maximum noradrenaline dose used and intestinal ischemia (p = 0,02), digital ischemia (p = 0,01) and therapeutic limitation decisions (p < 0,01). Conclusions: Despite septic shock association with very high mortality, the use of high-dose noradrenaline, even above 2,0 μg/kg/min, seems to be clinically useful to revert refractory septic shock, when used for a short period of time. Nevertheless, high dose noradrenaline is associated with higher frequency of ischemic complications and linked to end of life decisions.
Introduction: Refractory septic shock is associated with very high mortality and the vasopressor management isn’t yet consensual. Current recommendations do not define a maximum noradrenaline dose; therefore it is clinically difficult to establish the point of no therapeutic value. We intend to characterize noradrenaline use in septic shock and evaluate mortality and adverse effects associated with it. Methods: Retrospective analysis from all patients admitted to an Intensive Care Unit with a diagnosis of septic shock during the year 2018. Descriptive statistical analysis using non-parametric tests, as well as regression analysis, when adequate. Significance was defined as a p value < 0,05. Results: In our cohort of 173 patients, global mortality was 43,9%, reaching 78,7% in the subgroup of patients who received noradrenaline > 2,0 μg/kg/min, less than previously reported. In all patient subgroups, maximum noradrenaline dose was predominantly used during the first 48 hours after admission. In the subgroup of patients who received noradrenaline > 2,0 μg/kg/min, initial dose was 1,6 ± 1,3 μg/kg/min, maximum dose was 3,5 ± 1,2 μg/kg/min, and maximum dose duration was 5,9 ± 4,4 hours. There was an association between maximum noradrenaline dose used and intestinal ischemia (p = 0,02), digital ischemia (p = 0,01) and therapeutic limitation decisions (p < 0,01). Conclusions: Despite septic shock association with very high mortality, the use of high-dose noradrenaline, even above 2,0 μg/kg/min, seems to be clinically useful to revert refractory septic shock, when used for a short period of time. Nevertheless, high dose noradrenaline is associated with higher frequency of ischemic complications and linked to end of life decisions.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Keywords
Choque séptico refratário Noradrenalina Mortalidade Medicina intensiva