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Disparities in hemodynamic resuscitation of the obese critically ill septic shock patient.
J Crit Care. 2017 02; 37:219-223.JC

Abstract

BACKGROUND

With a growing obesity epidemic, the approach to care of this patient remains controversial and in many circumstances different than the general population. Appropriate hemodynamic support, although still controversial, remains a cornerstone of septic shock therapy. Catecholamines are currently recommended by guidelines without a preferred dosing strategy. However, the use of weight-based (μg kg-1 min-1) or nonweight-based (μg/min) vasopressor drip rates may impact patient care in these populations.

METHODS

A multicenter retrospective chart review was conducted. Patients receiving nonweight-based catecholamine infusions for septic shock were grouped into nonobese (n = 112) or obese (n = 196), and evaluated based on hemodynamic resuscitation. For the primary outcome, groups were analyzed for the requirement of a secondary hemodynamic support agent to obtain a goal mean arterial pressure of greater than or equal to 65 mm Hg. Secondary outcomes included an evaluation of time to a secondary hemodynamic support agent, time to hemodynamic stability (HDS), ability to obtain HDS at 24 hours, and death due to cardiovascular collapse.

RESULTS

With the exception of weight and sex, baseline characteristics were similar among groups. Early resuscitative fluids were given at a lower weight based, but not total volume dose in the obese group (nonobese, 34.8 mL/kg vs obese, 22.4 mL/kg; P < .0001). The primary end point of addition of any secondary hemodynamic support agent was significantly greater in obese patients when adjusted for institution (nonobese, 19% vs obese, 27%; adjusted odds ratio, 0.42; 95% confidence interval, 0.23-0.77). Time to HDS was also prolonged (nonobese, 3.5 hours vs obese, 5.3 hours; P = .006).

CONCLUSION

This study calls into question the adequacy of a nonweight-based approach to hemodynamic support of critically ill obese patients. This strategy seems to result in less aggressive, lower weight-based vasopressor and fluid doses, and more diverse approach than their nonobese counterparts.

Authors+Show Affiliations

St Vincent's Medical Center Riverside, Jacksonville, FL 32204.St Vincent's Medical Center Riverside, Jacksonville, FL 32204.St Vincent's Medical Center Riverside, Jacksonville, FL 32204.UF Health Jacksonville, Jacksonville, FL 32209.UF Health Jacksonville, Jacksonville, FL 32209.UF Health Jacksonville, Jacksonville, FL 32209.UF Health Jacksonville, Jacksonville, FL 32209.UF Health Jacksonville, Jacksonville, FL 32209. Electronic address: Jason.ferreira@jax.ufl.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27969574

Citation

Adams, Chere, et al. "Disparities in Hemodynamic Resuscitation of the Obese Critically Ill Septic Shock Patient." Journal of Critical Care, vol. 37, 2017, pp. 219-223.
Adams C, Tucker C, Allen B, et al. Disparities in hemodynamic resuscitation of the obese critically ill septic shock patient. J Crit Care. 2017;37:219-223.
Adams, C., Tucker, C., Allen, B., McRae, A., Balazh, J., Horst, S., Johnson, D., & Ferreira, J. (2017). Disparities in hemodynamic resuscitation of the obese critically ill septic shock patient. Journal of Critical Care, 37, 219-223. https://doi.org/10.1016/j.jcrc.2016.10.004
Adams C, et al. Disparities in Hemodynamic Resuscitation of the Obese Critically Ill Septic Shock Patient. J Crit Care. 2017;37:219-223. PubMed PMID: 27969574.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Disparities in hemodynamic resuscitation of the obese critically ill septic shock patient. AU - Adams,Chere, AU - Tucker,Calvin, AU - Allen,Bryan, AU - McRae,Andrew, AU - Balazh,Julia, AU - Horst,Spencer, AU - Johnson,Donald, AU - Ferreira,Jason, Y1 - 2016/10/11/ PY - 2016/06/01/received PY - 2016/10/01/revised PY - 2016/10/02/accepted PY - 2016/12/15/pubmed PY - 2017/10/5/medline PY - 2016/12/15/entrez KW - Catecholamine KW - Hemodynamics KW - Obesity KW - Shock KW - Vasoactive agents SP - 219 EP - 223 JF - Journal of critical care JO - J Crit Care VL - 37 N2 - BACKGROUND: With a growing obesity epidemic, the approach to care of this patient remains controversial and in many circumstances different than the general population. Appropriate hemodynamic support, although still controversial, remains a cornerstone of septic shock therapy. Catecholamines are currently recommended by guidelines without a preferred dosing strategy. However, the use of weight-based (μg kg-1 min-1) or nonweight-based (μg/min) vasopressor drip rates may impact patient care in these populations. METHODS: A multicenter retrospective chart review was conducted. Patients receiving nonweight-based catecholamine infusions for septic shock were grouped into nonobese (n = 112) or obese (n = 196), and evaluated based on hemodynamic resuscitation. For the primary outcome, groups were analyzed for the requirement of a secondary hemodynamic support agent to obtain a goal mean arterial pressure of greater than or equal to 65 mm Hg. Secondary outcomes included an evaluation of time to a secondary hemodynamic support agent, time to hemodynamic stability (HDS), ability to obtain HDS at 24 hours, and death due to cardiovascular collapse. RESULTS: With the exception of weight and sex, baseline characteristics were similar among groups. Early resuscitative fluids were given at a lower weight based, but not total volume dose in the obese group (nonobese, 34.8 mL/kg vs obese, 22.4 mL/kg; P < .0001). The primary end point of addition of any secondary hemodynamic support agent was significantly greater in obese patients when adjusted for institution (nonobese, 19% vs obese, 27%; adjusted odds ratio, 0.42; 95% confidence interval, 0.23-0.77). Time to HDS was also prolonged (nonobese, 3.5 hours vs obese, 5.3 hours; P = .006). CONCLUSION: This study calls into question the adequacy of a nonweight-based approach to hemodynamic support of critically ill obese patients. This strategy seems to result in less aggressive, lower weight-based vasopressor and fluid doses, and more diverse approach than their nonobese counterparts. SN - 1557-8615 UR - https://www.unboundmedicine.com/medline/citation/27969574/Disparities_in_hemodynamic_resuscitation_of_the_obese_critically_ill_septic_shock_patient_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(16)30612-8 DB - PRIME DP - Unbound Medicine ER -