Vasopressor dose equivalence: A scoping review and suggested formula

Goradia, Shruti; Sardaneh, Arwa Abu; Narayan, Sujita W.; Penm, Jonathan; Patanwala, Asad E.

doi:10.1016/j.jcrc.2020.11.002

Cited by 82 publications

(56 citation statements)

References 31 publications

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“…Vasopressors including norepinephrine, epinephrine, dopamine and dobutamine were recorded. Vasopressors were converted to equivalent dose of norepinephrine by the equation (all in mcg/kg/min, except vasopressin in units/min) [ 26 ]: Patients with 20% or more of missing values were excluded from analysis. For other patients with missing values, the longitudinal data were imputed by firstly applying last observation carried forward (LOCF) and then next observation carried backward (NOCB) methods [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Variablesmentioning

confidence: 99%

“…There were more male (912/1437, 63%) than female patients. The median APACHE II was 22 (IQR [16][17][18][19][20][21][22][23][24][25][26][27]. The primary site of infection included thorax (48%), abdomen (38%), UTI (7%) and soft tissue (3%).…”

Section: Participantsmentioning

confidence: 99%

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Individualized resuscitation strategy for septic shock formalized by finite mixture modeling and dynamic treatment regimen

Ma¹,

Liu

Shen

et al. 2021

Crit Care

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Background Septic shock comprises a heterogeneous population, and individualized resuscitation strategy is of vital importance. The study aimed to identify subclasses of septic shock with non-supervised learning algorithms, so as to tailor resuscitation strategy for each class. Methods Patients with septic shock in 25 tertiary care teaching hospitals in China from January 2016 to December 2017 were enrolled in the study. Clinical and laboratory variables were collected on days 0, 1, 2, 3 and 7 after ICU admission. Subclasses of septic shock were identified by both finite mixture modeling and K-means clustering. Individualized fluid volume and norepinephrine dose were estimated using dynamic treatment regime (DTR) model to optimize the final mortality outcome. DTR models were validated in the eICU Collaborative Research Database (eICU-CRD) dataset. Results A total of 1437 patients with a mortality rate of 29% were included for analysis. The finite mixture modeling and K-means clustering robustly identified five classes of septic shock. Class 1 (baseline class) accounted for the majority of patients over all days; class 2 (critical class) had the highest severity of illness; class 3 (renal dysfunction) was characterized by renal dysfunction; class 4 (respiratory failure class) was characterized by respiratory failure; and class 5 (mild class) was characterized by the lowest mortality rate (21%). The optimal fluid infusion followed the resuscitation/de-resuscitation phases with initial large volume infusion and late restricted volume infusion. While class 1 transitioned to de-resuscitation phase on day 3, class 3 transitioned on day 1. Classes 1 and 3 might benefit from early use of norepinephrine, and class 2 can benefit from delayed use of norepinephrine while waiting for adequate fluid infusion. Conclusions Septic shock comprises a heterogeneous population that can be robustly classified into five phenotypes. These classes can be easily identified with routine clinical variables and can help to tailor resuscitation strategy in the context of precise medicine.

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Section: Methodsmentioning

confidence: 99%

Section: Variablesmentioning

confidence: 99%

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Individualized resuscitation strategy for septic shock formalized by finite mixture modeling and dynamic treatment regimen

Ma¹,

Liu

Shen

et al. 2021

Crit Care

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“…We included any vasopressor infusion (norepinephrine, vasopressin, phenylephrine, epinephrine) to classify patients as receiving vasopressor at ICU admission. For description purposes and sensitivity analyses, we converted all vasopressors doses to norepinephrine equivalent in ug per kilogram per minute and combined them together to create a single total vasopressor dose variable (vasopressin was converted from units per minute to ug per kilogram per minute in a 1:2.5 ratio and phenylephrine was converted in a 10:1 ratio) [31][32][33].…”

Section: Exposuresmentioning

confidence: 99%

Association between intraoperative fluid balance, vasopressors and graft complications in liver transplantation: A cohort study

et al. 2021

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Introduction Biliary complications following liver transplantation are common. The effect of intraoperative fluid balance and vasopressors on these complications is unknown. Materials and methods We conducted a cohort study between July 2008 and December 2017. Our exposure variables were the total intraoperative fluid balance and the use of vasopressors on ICU admission. Our primary outcome was any biliary complication (anastomotic and non-anastomotic strictures) up to one year after transplantation. Our secondary outcomes were vascular complications, primary graft non-function and survival. Results We included 562 consecutive liver transplantations. 192 (34%) transplants had a biliary complication, 167 (30%) had an anastomotic stricture and 56 had a non-anastomotic stricture (10%). We did not observe any effect of intraoperative fluid balance or vasopressor on biliary complications (HR = 0.97; 95% CI, 0.93 to 1.02). A higher intraoperative fluid balance was associated with an increased risk of primary graft non-function (non-linear) and a lower survival (HR = 1.40, 95% CI, 1.14 to 1.71) in multivariable analyses. Conclusion Intraoperative fluid balance and vasopressors upon ICU admission were not associated with biliary complications after liver transplantation but may be associated with other adverse events. Intraoperative hemodynamic management must be prospectively studied to further assess their impact on liver recipients’ outcomes.

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“…10 However, this is not supported by current evidence. [10][11][12][13] There are limited studies evaluating the conversion dose ratio to determine the dose equivalence between metaraminol and norepinephrine in the critically ill. 1 There has been only one small study in 10 patients comparing the dosing of metaraminol to norepinephrine. 14 Based on this study, a recent scoping review has suggested that a conversion dose ratio of 8:1 (metaraminol μg.kg À1 .…”

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confidence: 99%

Dose equivalence between metaraminol and norepinephrine in critical care

Sardaneh

Goradia

Narayan

et al. 2021

Brit J Clinical Pharma

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Mean arterial pressure (MAP) and infusion doses for both drugs were collected at hourly intervals; 2 hours before to 5 hours after switching from metaraminol monotherapy to norepinephrine monotherapy. The conversion dose ratio was defined as the ratio of metaraminol (μg.kg À1 .min -1) : norepinephrine (μg.kg À1 .min À1 ) required to achieve a similar MAP.Results: A total of 43 out of 144 eligible patients were included. The median age was 68 years (IQR 56-76) and 22 (51%) were male. There was no significant difference between the baseline MAP during metaraminol monotherapy (median 71 mm Hg, IQR 66-76) and the post-transition MAP during norepinephrine monotherapy (median 70 mm Hg, IQR 66-73) (P = .09). The median conversion dose ratio between metaraminol and norepinephrine was 13 (IQR 7-24). In the sensitivity analyses, the median conversion dose ratio using the maximum and the mean norepinephrine infusion dose was 8 (IQR 5-16) and 12 (IQR 8-23), respectively. Conclusion:A conversion dose ratio of 10:1 (metaraminol μg.kg À1 .min À1 :norepinephrine μg.kg À1 .min À1 ) may be used in critically ill patients with shock to account for ease of calculations and variability of the conversion ratio in the primary and sensitivity analyses.

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Vasopressor dose equivalence: A scoping review and suggested formula

Cited by 82 publications

References 31 publications

Individualized resuscitation strategy for septic shock formalized by finite mixture modeling and dynamic treatment regimen

Individualized resuscitation strategy for septic shock formalized by finite mixture modeling and dynamic treatment regimen

Association between intraoperative fluid balance, vasopressors and graft complications in liver transplantation: A cohort study

Dose equivalence between metaraminol and norepinephrine in critical care

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