Evaluating the impact of obesity on safety and efficacy of weight-based norepinephrine dosing in septic shock: A single-center, retrospective study
Norepinephrine is the first-line vasopressor recommended for patients in septic shock. Weight-based dosing may increase drug exposure and the risk of adverse effects in obese patients. The objective was to evaluate the safety and efficacy of weight-based norepinephrine dosing using actual body weigh...
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| Veröffentlicht in: | Intensive & critical care nursing 2017-08, Vol.41, p.104-108 |
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| creator | Wong, Paul J. Pandya, Komal A. Flannery, Alexander H. |
| description | Norepinephrine is the first-line vasopressor recommended for patients in septic shock. Weight-based dosing may increase drug exposure and the risk of adverse effects in obese patients. The objective was to evaluate the safety and efficacy of weight-based norepinephrine dosing using actual body weight in the morbidly obese compared with normal weight patients.
This was a single centre, retrospective study of adult patients admitted with septic shock requiring norepinephrine for at least 12hours. The primary endpoint was the incidence of tachycardia within 48hours after norepinephrine initiation. Secondary endpoints included timing and dosing of norepinephrine when adjunctive agents were added.
The incidence of tachycardia was similar between groups. Total norepinephrine exposure was significantly greater in obese patients on day 1 (p=0.02). Obese patients were more likely to be started on vasopressin (p |
| doi_str_mv | 10.1016/j.iccn.2017.02.003 |
| format | Article |
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This was a single centre, retrospective study of adult patients admitted with septic shock requiring norepinephrine for at least 12hours. The primary endpoint was the incidence of tachycardia within 48hours after norepinephrine initiation. Secondary endpoints included timing and dosing of norepinephrine when adjunctive agents were added.
The incidence of tachycardia was similar between groups. Total norepinephrine exposure was significantly greater in obese patients on day 1 (p=0.02). Obese patients were more likely to be started on vasopressin (p<0.001) and steroids at a lower weight-based norepinephrine dose (p=0.016).
Weight-based norepinephrine dosing using actual body weight did not result in more tachycardia in the morbidly obese compared to normal weight patients, despite greater total exposure. These results were limited by the low doses used and a small cohort. However, use of actual body weight in morbidly obese patients appears to be safe.</description><identifier>ISSN: 0964-3397</identifier><identifier>EISSN: 1532-4036</identifier><identifier>DOI: 10.1016/j.iccn.2017.02.003</identifier><identifier>PMID: 28343834</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Adrenal glands ; Adult ; Aged ; Body Mass Index ; Body weight ; Catecholamines ; Critical care ; Critical illness ; Dosage ; Dose-Response Relationship, Drug ; Drug dosages ; Efficacy ; Female ; Hemodynamics - drug effects ; Humans ; Identification ; Kentucky ; Male ; Middle Aged ; Norepinephrine ; Norepinephrine - administration & dosage ; Norepinephrine - pharmacology ; Norepinephrine - therapeutic use ; Nurses ; Nursing ; Obesity ; Obesity - complications ; Obesity - drug therapy ; Patients ; Retrospective Studies ; Safety ; Sepsis ; Septic shock ; Shock, Septic - complications ; Shock, Septic - drug therapy ; Side effects ; Steroids ; Tachycardia - nursing ; Vasoconstrictor Agents - administration & dosage ; Vasoconstrictor Agents - pharmacology ; Vasoconstrictor Agents - therapeutic use ; Vasopressin</subject><ispartof>Intensive & critical care nursing, 2017-08, Vol.41, p.104-108</ispartof><rights>2017 Elsevier Ltd</rights><rights>Copyright © 2017 Elsevier Ltd. All rights reserved.</rights><rights>Copyright Elsevier Limited Aug 1, 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-dd4d931b8e25bc6dc69151b09734444c0edeaa499a7949bebb152a4ac41134573</citedby><cites>FETCH-LOGICAL-c384t-dd4d931b8e25bc6dc69151b09734444c0edeaa499a7949bebb152a4ac41134573</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1912670564?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,776,780,3536,12826,27903,27904,30978,45974,64362,64364,64366,72216</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28343834$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wong, Paul J.</creatorcontrib><creatorcontrib>Pandya, Komal A.</creatorcontrib><creatorcontrib>Flannery, Alexander H.</creatorcontrib><title>Evaluating the impact of obesity on safety and efficacy of weight-based norepinephrine dosing in septic shock: A single-center, retrospective study</title><title>Intensive & critical care nursing</title><addtitle>Intensive Crit Care Nurs</addtitle><description>Norepinephrine is the first-line vasopressor recommended for patients in septic shock. Weight-based dosing may increase drug exposure and the risk of adverse effects in obese patients. The objective was to evaluate the safety and efficacy of weight-based norepinephrine dosing using actual body weight in the morbidly obese compared with normal weight patients.
This was a single centre, retrospective study of adult patients admitted with septic shock requiring norepinephrine for at least 12hours. The primary endpoint was the incidence of tachycardia within 48hours after norepinephrine initiation. Secondary endpoints included timing and dosing of norepinephrine when adjunctive agents were added.
The incidence of tachycardia was similar between groups. Total norepinephrine exposure was significantly greater in obese patients on day 1 (p=0.02). Obese patients were more likely to be started on vasopressin (p<0.001) and steroids at a lower weight-based norepinephrine dose (p=0.016).
Weight-based norepinephrine dosing using actual body weight did not result in more tachycardia in the morbidly obese compared to normal weight patients, despite greater total exposure. These results were limited by the low doses used and a small cohort. However, use of actual body weight in morbidly obese patients appears to be safe.</description><subject>Adrenal glands</subject><subject>Adult</subject><subject>Aged</subject><subject>Body Mass Index</subject><subject>Body weight</subject><subject>Catecholamines</subject><subject>Critical care</subject><subject>Critical illness</subject><subject>Dosage</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug dosages</subject><subject>Efficacy</subject><subject>Female</subject><subject>Hemodynamics - drug effects</subject><subject>Humans</subject><subject>Identification</subject><subject>Kentucky</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Norepinephrine</subject><subject>Norepinephrine - administration & dosage</subject><subject>Norepinephrine - pharmacology</subject><subject>Norepinephrine - therapeutic use</subject><subject>Nurses</subject><subject>Nursing</subject><subject>Obesity</subject><subject>Obesity - complications</subject><subject>Obesity - drug therapy</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Safety</subject><subject>Sepsis</subject><subject>Septic shock</subject><subject>Shock, Septic - complications</subject><subject>Shock, Septic - drug therapy</subject><subject>Side effects</subject><subject>Steroids</subject><subject>Tachycardia - nursing</subject><subject>Vasoconstrictor Agents - administration & dosage</subject><subject>Vasoconstrictor Agents - pharmacology</subject><subject>Vasoconstrictor Agents - therapeutic use</subject><subject>Vasopressin</subject><issn>0964-3397</issn><issn>1532-4036</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kc1u1DAUhS1ERYfCC7BAltiwIMGOnR-jbqqqQKVK3cDa8s9Nx0PGDrYzaJ6DF8bRFBYsasn2lfWdI997EHpDSU0J7T7uameMrxtC-5o0NSHsGdrQljUVJ6x7jjZEdLxiTPTn6GVKO0KIYEP7Ap03A-Os7A36fXNQ06Ky8w84bwG7_axMxmHEQUNy-YiDx0mNUCrlLYZxdEaZ40r8AvewzZVWCSz2IcLsPMzbWE5sQ1otXRHDnJ3BaRvMj0_4Cq_vE1QGfIb4AUfIMaQZTHYHwCkv9vgKnY1qSvD68b5A3z_ffLv-Wt3df7m9vrqrDBt4rqzlVjCqB2habTprOkFbqonoGS_LELCgFBdC9YILDVrTtlFcGU4p423PLtD7k-8cw88FUpZ7lwxMk_IQliTpMFDOh5Z0BX33H7oLS_Tld5IK2nQ9aTteqOZEmdJSijDKObq9ikdJiVwjkzu5RibXyCRpZImsiN4-Wi96D_af5G9GBbg8AVBmcXAQZTIOvAHrYhmbtME95f8H0GupWw</recordid><startdate>201708</startdate><enddate>201708</enddate><creator>Wong, Paul J.</creator><creator>Pandya, Komal A.</creator><creator>Flannery, Alexander H.</creator><general>Elsevier Ltd</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7QJ</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HEHIP</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M2S</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>201708</creationdate><title>Evaluating the impact of obesity on safety and efficacy of weight-based norepinephrine dosing in septic shock: A single-center, retrospective study</title><author>Wong, Paul J. ; Pandya, Komal A. ; Flannery, Alexander H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-dd4d931b8e25bc6dc69151b09734444c0edeaa499a7949bebb152a4ac41134573</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adrenal glands</topic><topic>Adult</topic><topic>Aged</topic><topic>Body Mass Index</topic><topic>Body weight</topic><topic>Catecholamines</topic><topic>Critical care</topic><topic>Critical illness</topic><topic>Dosage</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug dosages</topic><topic>Efficacy</topic><topic>Female</topic><topic>Hemodynamics - drug effects</topic><topic>Humans</topic><topic>Identification</topic><topic>Kentucky</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Norepinephrine</topic><topic>Norepinephrine - administration & dosage</topic><topic>Norepinephrine - pharmacology</topic><topic>Norepinephrine - therapeutic use</topic><topic>Nurses</topic><topic>Nursing</topic><topic>Obesity</topic><topic>Obesity - complications</topic><topic>Obesity - drug therapy</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Safety</topic><topic>Sepsis</topic><topic>Septic shock</topic><topic>Shock, Septic - complications</topic><topic>Shock, Septic - drug therapy</topic><topic>Side effects</topic><topic>Steroids</topic><topic>Tachycardia - nursing</topic><topic>Vasoconstrictor Agents - administration & dosage</topic><topic>Vasoconstrictor Agents - pharmacology</topic><topic>Vasoconstrictor Agents - therapeutic use</topic><topic>Vasopressin</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wong, Paul J.</creatorcontrib><creatorcontrib>Pandya, Komal A.</creatorcontrib><creatorcontrib>Flannery, Alexander H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection</collection><collection>ProQuest Central (Corporate)</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Social Science Premium Collection</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>Sociology Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Sociology Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Intensive & critical care nursing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wong, Paul J.</au><au>Pandya, Komal A.</au><au>Flannery, Alexander H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluating the impact of obesity on safety and efficacy of weight-based norepinephrine dosing in septic shock: A single-center, retrospective study</atitle><jtitle>Intensive & critical care nursing</jtitle><addtitle>Intensive Crit Care Nurs</addtitle><date>2017-08</date><risdate>2017</risdate><volume>41</volume><spage>104</spage><epage>108</epage><pages>104-108</pages><issn>0964-3397</issn><eissn>1532-4036</eissn><abstract>Norepinephrine is the first-line vasopressor recommended for patients in septic shock. Weight-based dosing may increase drug exposure and the risk of adverse effects in obese patients. The objective was to evaluate the safety and efficacy of weight-based norepinephrine dosing using actual body weight in the morbidly obese compared with normal weight patients.
This was a single centre, retrospective study of adult patients admitted with septic shock requiring norepinephrine for at least 12hours. The primary endpoint was the incidence of tachycardia within 48hours after norepinephrine initiation. Secondary endpoints included timing and dosing of norepinephrine when adjunctive agents were added.
The incidence of tachycardia was similar between groups. Total norepinephrine exposure was significantly greater in obese patients on day 1 (p=0.02). Obese patients were more likely to be started on vasopressin (p<0.001) and steroids at a lower weight-based norepinephrine dose (p=0.016).
Weight-based norepinephrine dosing using actual body weight did not result in more tachycardia in the morbidly obese compared to normal weight patients, despite greater total exposure. These results were limited by the low doses used and a small cohort. However, use of actual body weight in morbidly obese patients appears to be safe.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>28343834</pmid><doi>10.1016/j.iccn.2017.02.003</doi><tpages>5</tpages></addata></record> |
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| ispartof | Intensive & critical care nursing, 2017-08, Vol.41, p.104-108 |
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| subjects | Adrenal glands Adult Aged Body Mass Index Body weight Catecholamines Critical care Critical illness Dosage Dose-Response Relationship, Drug Drug dosages Efficacy Female Hemodynamics - drug effects Humans Identification Kentucky Male Middle Aged Norepinephrine Norepinephrine - administration & dosage Norepinephrine - pharmacology Norepinephrine - therapeutic use Nurses Nursing Obesity Obesity - complications Obesity - drug therapy Patients Retrospective Studies Safety Sepsis Septic shock Shock, Septic - complications Shock, Septic - drug therapy Side effects Steroids Tachycardia - nursing Vasoconstrictor Agents - administration & dosage Vasoconstrictor Agents - pharmacology Vasoconstrictor Agents - therapeutic use Vasopressin |
| title | Evaluating the impact of obesity on safety and efficacy of weight-based norepinephrine dosing in septic shock: A single-center, retrospective study |
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