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Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
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Vasopressor Discontinuation Order in Septic Shock With Reduced Left Ventricular Function.
Ashley Taylor1,2, Timothy Jones2, Christy Cecil Forehand1,2
1Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA.
Journal of Pharmacy Practice
|May 12, 2021
Summary
The order of discontinuing vasopressors like norepinephrine and vasopressin does not affect hypotension in septic shock patients with left ventricular dysfunction. However, it may influence intensive care unit length of stay.
Area of Science:
- Critical Care Medicine
- Cardiology
- Pharmacology
Background:
- Optimal vasopressor management for septic patients with left ventricular (LV) dysfunction remains unclear.
- Evidence conflicts on the best order for discontinuing vasopressors in these patients.
Purpose of the Study:
- To assess the impact of LV dysfunction on hemodynamic management in septic shock.
- To determine the incidence of significant hypotension after vasopressor discontinuation.
Main Methods:
- Retrospective cohort study of adult septic shock patients with LV dysfunction (ejection fraction ≤40%).
- Patients received norepinephrine and vasopressin as the last vasopressors.
- Primary outcome: clinically significant hypotension post-vasopressor discontinuation.
Main Results:
- No significant difference in hypotension incidence when discontinuing vasopressin first (76%) versus norepinephrine first (81%).
- ICU length of stay was shorter when vasopressin was discontinued first (9 days) compared to norepinephrine (15 days).
- No statistically significant difference in mortality was observed between groups.
Conclusions:
- Discontinuation order of norepinephrine and vasopressin did not affect hypotension in septic shock with LV dysfunction.
- The order may influence ICU length of stay, but other factors could be involved.
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