Norepinephrine Dosing in Obese and Nonobese Patients With Septic Shock

2016 ◽  
Vol 25 (1) ◽  
pp. 27-32 ◽  
Author(s):  
John J. Radosevich ◽  
Asad E. Patanwala ◽  
Brian L. Erstad
Keyword(s):  
Body Mass Index ◽  
Septic Shock ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Body Mass ◽  
Secondary Outcome ◽  
Obese Patients ◽  
Hemodynamic Status ◽  
Norepinephrine Infusion ◽  
Nonobese Patients

Background Whether or not norepinephrine infusions for support of hemodynamic status in patients with septic shock should be weight based is unknown. This situation is particularly pertinent in patients who are extremely overweight or obese. Objective To compare dosing requirements and effect of norepinephrine on blood pressure in obese and nonobese patients with septic shock. Methods In a retrospective cohort study, data on adult patients with septic shock who received norepinephrine infusion for support of hemodynamic status in a tertiary care, academic medical center were analyzed. Patients were categorized as obese (body mass index ≥ 30) or nonobese (body mass index < 30). The primary outcome was dosing requirements of norepinephrine at 60 minutes after the start of the infusion. The secondary outcome was the log-transformed ratio of mean arterial pressure to norepinephrine. Results The final cohort consisted of 100 obese and 100 nonobese patients. Mean norepinephrine infusion rate at 60 minutes was 0.09 (SD, 0.08) μg/kg per minute in the obese group and 0.13 (SD, 0.14) μg/kg per minute in the nonobese group (P = .006). The non–weight-based dose at 60 minutes was 9 μg/min in obese patients and 8 μg/min in nonobese patients (P = .72). The log transformed mean arterial pressure to norepinephrine ratio at 60 minutes was 2.5 (SD, 0.9) in obese patients and 2.5 (SD, 0.8) in nonobese patients (P = .54) Conclusions Compared with nonobese patients, obese patients with septic shock require lower weight-based doses of norepinephrine and similar total norepinephrine doses.

Impact of Norepinephrine Weight-Based Dosing Compared With Non–Weight-Based Dosing in Achieving Time to Goal Mean Arterial Pressure in Obese Patients With Septic Shock

2016 ◽  
Vol 51 (3) ◽  
pp. 194-202 ◽  
Author(s):  
Nina Vadiei ◽  
Mitchell J. Daley ◽  
Manasa S. Murthy ◽  
Carrie S. Shuman
Keyword(s):  
Septic Shock ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Primary Outcome ◽  
Obese Patients ◽  
First Line ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Norepinephrine Dose ◽  
Goal Map

Background: Currently, a lack of standardization exists in norepinephrine dosing units, the first-line vasopressor for septic shock. Timely achievement of goal mean arterial pressure (MAP) is dependent on optimal vasopressor dosing. Objective: To determine if weight-based dosing (WBD) of norepinephrine leads to earlier time to goal MAP compared with non-WBD in obese patients with septic shock. Methods: This was a retrospective, multicenter cohort study. Patients had a body mass index (BMI) ≥30 kg/m2 and received norepinephrine for septic shock with either a non-WBD strategy (between December 2009 and January 2013) or WBD strategy (between January 2013 and December 2015). The primary outcome was time to goal MAP. Secondary outcomes were norepinephrine duration, dose requirements, and development of treatment-related complications. Results: A total of 287 patients were included (WBD 144; non-WBD 143). There was no difference in median time to goal MAP (WBD 58 minutes, interquartile range [IQR] = 16.8-118.5, vs non-WBD 60 minutes, IQR = 17.5-193.5; P = 0.28). However, there was a difference in median cumulative norepinephrine dose (WBD 12.6 mg, IQR = 4.9-45.9, vs non-WBD 10.5 mg, IQR = 3.9-25.6; P = 0.04) and time to norepinephrine discontinuation (WBD 33 hours, IQR = 15-69, vs non-WBD 27 hours, IQR = 12-51; P = 0.03). There was no difference in rates of atrial fibrillation (WBD 15.3% vs non-WBD 23.7%; P = 0.07) or mortality (WBD 23.6% vs non-WBD 23.1%; P = 0.92). Conclusion: WBD of norepinephrine does not achieve time to goal MAP earlier in obese patients with septic shock. However, WBD may lead to higher norepinephrine cumulative dose requirements and prolonged time until norepinephrine discontinuation.

scholarly journals Correlation of Body Mass Index, Mean Arterial Pressure with Peak Expiratory Flow Rate in Healthy Individuals- A Descriptive Study

2021 ◽  
Author(s):  
Tanuj Mathur ◽  
Dileep Kumar Verma ◽  
Sunita Tiwari ◽  
Narsingh Verma ◽  
Ranjana Singh
Keyword(s):  
Body Mass Index ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Body Mass ◽  
Peak Expiratory Flow ◽  
Flow Rate ◽  
Peak Expiratory Flow Rate ◽  
Healthy Individuals ◽  
Cross Sectional ◽  
Expiratory Flow

Introduction: Modern lifestyle has resulted in an increased prevalence of cardiovascular and respiratory diseases along with being overweight. An interaction between the three factors has also been demonstrated. Aim: The study aimed to assess the relationship of Body Mass Index (BMI), Mean Arterial Pressure (MAP) and Peak Expiratory Flow Rate (PEFR) in healthy individuals. Materials and Methods: This cross-sectional, observational study was done in the Department of Physiology, KGMU, Lucknow from 30 July 2019 to 30 July 2020. Forty healthy individuals, aged 18-35 years were assessed for height, weight, blood pressure and spirometric parameter of PEFR. PEFR was chosen as it was a reliable representative of airways functioning. PEFR reflects proximal airway calibre changes which might be due to effect of airway geometry. A correlation test was run to test the relation between BMI and PEFR and MAP and PEFR. Results: A weak correlation (r=-0.136) was noted between BMI and PEFR indicating that as BMI increased, PEFR compromised. A linear correlation was observed between MAP and PEFR. Conclusion: The present study confirms a weak association of BMI and MAP with PEFR.

Sex Differences in Correlates of Steady State and Pulsatile Component of Blood Pressure

1996 ◽  
Vol 91 (4) ◽  
pp. 385-389 ◽  
Author(s):  
A. Scuteri ◽  
A. M. Cacciafesta ◽  
M. G. Di Bernardo ◽  
A. M. De Propris ◽  
D. Recchi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Regression Analysis ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Multiple Regression Analysis ◽  
Multiple Regression ◽  
Body Mass ◽  
Pulse Pressure ◽  
Coronary Insufficiency

1. The aim of the present study was to evaluate whether metabolic factors are linked to the steady component and the pulsatile component of blood pressure, evaluated as mean arterial pressure and pulse pressure respectively, in a sex-specific manner. 2. A cohort of 299 subjects (152 males, 147 females; 25–80 years of age) was studied. Patients presenting congestive heart failure, coronary insufficiency, severe valvular heart disease, neurological accident in the last 6 months, renal or respiratory failure, cancer, diabetes mellitus or acute infectious disease were excluded. None of the women was taking oral contraceptives or oestrogen supplementation. All cardioactive drugs were withdrawn at least 2 weeks before the subjects entered the study. 3. Men presented higher mean arterial pressure (120 ± 15 compared with 115 ± 16 mmHg, P < 0.01) and lower pulse pressure values (63 ± 16 compared with 67 ± 18 mmHg, P < 0.05) than women. In men, no significant relation between mean arterial pressure and the tested variables was detected; multiple regression analysis demonstrated that age contributed independently to the model for pulse pressure with a multiple r2 of 0.10 (P < 0.01). In women, body mass index contributed independently to the model for mean arterial pressure, with a multiple of 0.12 (P < 0.005); age and, to a lesser extent, body mass index, glycaemia and triglyceridaemia persisted as independent determinants of pulse pressure at the multiple regression analysis, with a multiple r2 of 0.20 (P < 0.001). 4. Our findings suggest that metabolic risk factors are associated differently with pulse pressure and mean arterial pressure values in the two sexes.

Clinical Outcomes of Weight-Based Norepinephrine Dosing in Underweight and Morbidly Obese Patients: A Propensity-Matched Analysis

2018 ◽  
Vol 35 (6) ◽  
pp. 554-561 ◽  
Author(s):  
Aditya A. Kotecha ◽  
Saraschandra Vallabhajosyula ◽  
Dinesh R. Apala ◽  
Erin Frazee ◽  
Vivek N. Iyer
Keyword(s):  
Body Mass Index ◽  
Septic Shock ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Body Mass ◽  
Odds Ratio ◽  
Kidney Injury ◽  
Normal Weight ◽  
Morbidly Obese ◽  
Obese Patients

Background: Weight-based dosing strategy for norepinephrine in septic shock patients with extremes of body mass index has been lesser studied. Methods: This historical study of adult septic shock patients was conducted from January 1, 2010, to December 31, 2015, at all intensive care units (ICUs) in Mayo Clinic, Rochester. Patients with documented body mass index were classified into underweight (body mass index <18.5 kg/m2), normal weight (18.5-24.9 kg/m2), and morbidly obese (≥40 kg/m2) patients. Patients with repeat ICU admissions, ICU stay <1 day, and body mass index 25 to 39.9 kg/m2 were excluded. The primary outcome was in-hospital mortality, and secondary outcomes included cumulative norepinephrine exposure acute kidney injury, cardiac arrhythmias, and 1-year mortality. Two-tailed P < .05 was considered statistically significant. Results: From 2010 to 2015, 2016 patients met inclusion—145, 1406, and 466 patients, respectively, in underweight, normal weight, and morbidly obese cohorts. Underweight patients used the highest peak dose and absolute exposure was greatest for morbidly obese patients. In-hospital mortality decreased with increasing log10 body mass index: 41.4% (underweight), 28.4% (normal weight), and 24.7% (morbidly obese), respectively ( P < .001); however, this relationship was not noted at 1 year. Unadjusted log10 norepinephrine cumulative exposure (mg) was associated with higher in-hospital mortality, acute kidney injury, cardiac arrhythmias, and 1-year mortality. After adjustment for demographics, body mass index, comorbidity, and illness severity, log10 norepinephrine exposure was an independent predictor of in-hospital mortality (odds ratio 2.4 [95% confidence interval, 2.0-2.8]; P < .001) and 1-year mortality (odds ratio 1.7 [95% confidence interval, 1.5-2.0]; P < .001). In a propensity-matched analysis of 1140 patients, log10 norepinephrine was an independent predictor of in-hospital mortality (odds ratio 2.2 [95% confidence interval, 1.8-2.6]; P < .001). Conclusions: Morbidly obese patients had lower in-hospital mortality but had higher 1-year mortality compared to normal weight and underweight patients. Cumulative norepinephrine exposure was highest in morbidly obese patients. Total norepinephrine exposure was an independent mortality predictor in septic shock.

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