Impact of Starting Dose of Vasopressor on Hemodynamic Response in Shock

Impact of Starting Dose of Vasopressor on Hemodynamic Response in Shock

This study is designed to assess the effect of initial vasopressor dose on clinical outcomes. To date, there are no clinical guidelines or recommendations regarding the dose of vasopressor medication that should be initiated before titrating to a mean arterial pressure (MAP) in patients with circulatory shock. High heterogeneity and clinical equipoise regarding this variable exist in routine clinical practice. However, there is strong evidence that delays in achieving MAP goals lead to worse clinical outcomes. The study will randomize patients with circulatory shock to a low (5mcg/min of norepinephrine) or high (15mcg/min of norepinephrine) initial starting dose followed by the usual protocolized titration to MAP goal. The time to reach the goal MAP, organ dysfunction, hospital length of stay, and mortality will be measured for each group.

Inclusion Criteria:

• Patients at least 18 years old
• Patients who are diagnosed with shock (MAP < 65 mmHg) require the initiation of vasopressors
• Care provided in the ED or admission to the Medical Intensive Care Unit (MICU)
• Norepinephrine chosen as first-line vasopressor by the treating clinician

Exclusion Criteria:

• Patients who are receiving vasopressors or inotropes prior to UI Health hospital presentation/admission
• Baseline MAP >/= 65 mmHg
• Pregnant patients (checked as standard of care on admission)
• Prisoners.
• Immediate post-cardiac arrest patients