Volume 5 Supplement 3

First International Symposium on Intensive Care and Emergency Medicine for Latin America:

Open Access

Severity stratification of septic shock according to noradrenaline requirement

  • G Hernández1,
  • A Bruhn1,
  • D Acuña1,
  • FJ Larrondo1,
  • R Martinez1,
  • S Medeiros1,
  • C Fierro1,
  • R De La Fuente1,
  • L Castillo1 and
  • G Bugedo1
Critical Care20015(Suppl 3):P31

DOI: 10.1186/cc1364

Published: 26 June 2001

Introduction

Septic shock (SS) is associated with 50% mortality. Severity is usually estimated from indexes of MODS, but hemodynamic dysfunction, despite its main role, has traditionally been underscored. The aim of this study was to test a severity classification for SS according to noradrenaline (NA) requirements.

Method

An algorithm for hemodynamic treatment in SS, which established NA as the initial vasoactive drug (followed by dobutamine or adrenaline as required), was followed prospectively in all SS patients from December 1999 to August 2000. We evaluated APACHEII and SOFA scores, maximum values for C-reactive protein (CPR) and lactate, hemodynamic profiles, and renal, respiratory and hepatic dysfunction. Patients were classified in three groups according to the maximum NA requirement: mild, NA <0.1 μg/kg/min; moderate, NA 0.1-0.3 μg/kg/min; and severe, NA >0.3 μg/kg/min.

Results

Results are expressed as mean ± SD (Table).

Table

 

Mild

Moderate

Severe

 
 

(n = 15)

(n = 17)

(n = 24)

P

Age years

64.4 ± 20.6

62.8 ± 14.1

58.5 ± 14.5

NS

Sex (F/M)

5/10

9/8

14/10

NS

APACHE II

15.2 ± 6

13.7 ± 7

20.8 ± 6.2

†‡

Max SOFA

6.8 ± 3.3

7.5 ± 3.3

11.9 ± 3

†‡

Max lactate mg/dl

3 ± 2.1

2.6 ± 1.7

7.5 ± 3.9

†‡

Max CRP mg/dl

27.8 ± 13.5

29.1 ± 8.1

26.7 ± 12.5

NS

Days in MV

4 ± 4.2

7.2 ± 9.7

5.2 ± 4.7

NS

Max creat mg/dl

1.7 ± 0.6

2.9 ± 3.2

2.3 ± 1.4

NS

Mortality (%)

3 (20%)

4 (23.5%)

17 (70.8%)

†‡

P < 0.05 *mild versus moderate; moderate versus severe; mild versus severe.

Conclusion

Noradrenaline requirement >0.3 μg/kg/min is associated with high mortality in SS. Based on these results, a new and strong criterium for severe septic shock is proposed. We also showed the feasibility of applying a predefined algorithm for hemodynamic treatment.

Authors’ Affiliations

(1)
Programa de Medicina Intensiva, Departamento de Anestesiología, Pontificia Universidad Católica de Chile

Copyright

© The Author(s) 2001

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