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Arterial Hypotension Following Norepinephrine Decrease in Septic Shock Patients Is Not Related to Preload Dependence:

Stefan Andrei1,2, Maxime Nguyen1,3, Osama Abou-Arab4

  • 1Anaesthesiology and Critical Care Department, Dijon Bourgogne University Hospital, Dijon, France.

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|March 11, 2022
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Summary

Preload dependence does not predict hypotension when weaning norepinephrine in septic shock patients. Fluid expansion did not improve outcomes in patients who became hypotensive after norepinephrine reduction.

Keywords:
dynamic arterial elastancenorepinephrine weaningpreload responsivenessseptic shockvolume therapy

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Area of Science:

  • Critical Care Medicine
  • Hemodynamics
  • Septic Shock Management

Background:

  • Optimal management of hypotension during norepinephrine weaning remains unclear.
  • Norepinephrine (Levophed) is a vasopressor commonly used in septic shock.
  • Predicting and managing hypotension during vasopressor de-escalation is crucial.

Purpose of the Study:

  • To determine if preload dependence can predict hypotension after norepinephrine weaning.
  • To assess the impact of norepinephrine weaning on preload dependence.
  • To evaluate the cardiovascular effects of fluid expansion in hypotensive patients post-norepinephrine.

Main Methods:

  • Prospective observational monocentric study.
  • Included PiCCO®-monitored patients with norepinephrine-treated septic shock undergoing de-escalation.
  • Hemodynamic measurements taken at baseline, after norepinephrine decrease, and after fluid expansion.

Main Results:

  • Preload dependence (assessed by passive leg raising) did not predict pressure response to norepinephrine weaning (AUC 0.42, p=0.395).
  • No significant difference in prior preload dependence between pressure responders and non-responders after fluid expansion (14% vs 13%, p=1).
  • Arterial hypotension after norepinephrine decrease was not associated with fluid responsiveness (40% vs 23%, p=0.211).

Conclusions:

  • Preload dependence is not a reliable predictor of hypotension during norepinephrine weaning.
  • Fluid expansion did not show a significant association with improved pressure response in hypotensive patients after norepinephrine reduction.