Dose equivalence for metaraminol and noradrenaline – A retrospective analysis
Noradrenaline and metaraminol are commonly used vasopressors in critically ill patients. However, little is known of their dose equivalence. We conducted a single centre retrospective cohort study of all ICU patients who transitioned from metaraminol to noradrenaline infusions between August 26, 201...
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| Veröffentlicht in: | Journal of critical care 2024-04, Vol.80, p.154430, Article 154430 |
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| creator | Costa-Pinto, Rahul Neto, Ary Serpa Matthewman, Madeline Coxwell Osrin, Dean Liskaser, Grace Li, Jasun Young, Marcus Jones, Daryl Udy, Andrew Warrillow, Stephen Bellomo, Rinaldo |
| description | Noradrenaline and metaraminol are commonly used vasopressors in critically ill patients. However, little is known of their dose equivalence.
We conducted a single centre retrospective cohort study of all ICU patients who transitioned from metaraminol to noradrenaline infusions between August 26, 2016 and December 31, 2020. Patients receiving additional vasoactive drug infusion were excluded. Dose equivalence was calculated based on the last hour metaraminol dose (in μg/min) and the first hour noradrenaline dose (in μg/min) with the closest matched mean arterial pressure (MAP). Sensitivity analyses were performed on patients with acute kidney injury (AKI), sepsis and mechanical ventilation.
We studied 195 patients. The median conversion ratio of metaraminol to noradrenaline was 12.5:1 (IQR 7.5–20.0) for the overall cohort. However, the coefficient of variation was 77% and standard deviation was 11.8. Conversion ratios were unaffected by sepsis or mechanical ventilation but increased (14:1) with AKI. One in five patients had a MAP decrease of >10 mmHg during the transition period from metaraminol to noradrenaline. Post-transition noradrenaline dose (p 10 mmHg when transitioning between vasopressors |
| doi_str_mv | 10.1016/j.jcrc.2023.154430 |
| format | Article |
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We conducted a single centre retrospective cohort study of all ICU patients who transitioned from metaraminol to noradrenaline infusions between August 26, 2016 and December 31, 2020. Patients receiving additional vasoactive drug infusion were excluded. Dose equivalence was calculated based on the last hour metaraminol dose (in μg/min) and the first hour noradrenaline dose (in μg/min) with the closest matched mean arterial pressure (MAP). Sensitivity analyses were performed on patients with acute kidney injury (AKI), sepsis and mechanical ventilation.
We studied 195 patients. The median conversion ratio of metaraminol to noradrenaline was 12.5:1 (IQR 7.5–20.0) for the overall cohort. However, the coefficient of variation was 77% and standard deviation was 11.8. Conversion ratios were unaffected by sepsis or mechanical ventilation but increased (14:1) with AKI. One in five patients had a MAP decrease of >10 mmHg during the transition period from metaraminol to noradrenaline. Post-transition noradrenaline dose (p < 0.001) and AKI (p = 0.045) were independently associated with metaraminol dose. The proportion of variation in noradrenaline dose predicted from metaraminol dose was low (R2 = 0.545).
The median dose equivalence for metaraminol and noradrenaline in this study was 12.5:1. However, there was significant variance in dose equivalence, only half the proportion of variation in noradrenaline infusion dose was predicted by metaraminol dose, and conversion-associated hypotension was common.
•Median dose equivalence for metaraminol and noradrenaline in this study was 12.5:1•There was significant variance in dose equivalence between the two vasopressors•Only half the variation in noradrenaline could be predicted from metaraminol dose•21% of patients had a MAP decrease >10 mmHg when transitioning between vasopressors</description><identifier>ISSN: 0883-9441</identifier><identifier>ISSN: 1557-8615</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2023.154430</identifier><identifier>PMID: 38245376</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute kidney injury ; Acute Kidney Injury - complications ; Cohort analysis ; Creatinine ; Dose equivalence ; Drug dosages ; Ethics ; Hemodynamics ; Humans ; Intensive care ; Kidneys ; Metaraminol ; Noradrenaline ; Norepinephrine ; Patients ; Ratios ; Retrospective Studies ; Sepsis ; Sepsis - complications ; Vasodilatory shock ; Ventilators</subject><ispartof>Journal of critical care, 2024-04, Vol.80, p.154430, Article 154430</ispartof><rights>2023</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><rights>2023. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c335t-55e54e2ce6cec58b29b11f11833eba8d7f8231a62dfef06c3404982ae033be453</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2916415626?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,777,781,27906,27907,64365,64367,64369,72219</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38245376$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Costa-Pinto, Rahul</creatorcontrib><creatorcontrib>Neto, Ary Serpa</creatorcontrib><creatorcontrib>Matthewman, Madeline Coxwell</creatorcontrib><creatorcontrib>Osrin, Dean</creatorcontrib><creatorcontrib>Liskaser, Grace</creatorcontrib><creatorcontrib>Li, Jasun</creatorcontrib><creatorcontrib>Young, Marcus</creatorcontrib><creatorcontrib>Jones, Daryl</creatorcontrib><creatorcontrib>Udy, Andrew</creatorcontrib><creatorcontrib>Warrillow, Stephen</creatorcontrib><creatorcontrib>Bellomo, Rinaldo</creatorcontrib><title>Dose equivalence for metaraminol and noradrenaline – A retrospective analysis</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>Noradrenaline and metaraminol are commonly used vasopressors in critically ill patients. However, little is known of their dose equivalence.
We conducted a single centre retrospective cohort study of all ICU patients who transitioned from metaraminol to noradrenaline infusions between August 26, 2016 and December 31, 2020. Patients receiving additional vasoactive drug infusion were excluded. Dose equivalence was calculated based on the last hour metaraminol dose (in μg/min) and the first hour noradrenaline dose (in μg/min) with the closest matched mean arterial pressure (MAP). Sensitivity analyses were performed on patients with acute kidney injury (AKI), sepsis and mechanical ventilation.
We studied 195 patients. The median conversion ratio of metaraminol to noradrenaline was 12.5:1 (IQR 7.5–20.0) for the overall cohort. However, the coefficient of variation was 77% and standard deviation was 11.8. Conversion ratios were unaffected by sepsis or mechanical ventilation but increased (14:1) with AKI. One in five patients had a MAP decrease of >10 mmHg during the transition period from metaraminol to noradrenaline. Post-transition noradrenaline dose (p < 0.001) and AKI (p = 0.045) were independently associated with metaraminol dose. The proportion of variation in noradrenaline dose predicted from metaraminol dose was low (R2 = 0.545).
The median dose equivalence for metaraminol and noradrenaline in this study was 12.5:1. However, there was significant variance in dose equivalence, only half the proportion of variation in noradrenaline infusion dose was predicted by metaraminol dose, and conversion-associated hypotension was common.
•Median dose equivalence for metaraminol and noradrenaline in this study was 12.5:1•There was significant variance in dose equivalence between the two vasopressors•Only half the variation in noradrenaline could be predicted from metaraminol dose•21% of patients had a MAP decrease >10 mmHg when transitioning between vasopressors</description><subject>Acute kidney injury</subject><subject>Acute Kidney Injury - complications</subject><subject>Cohort analysis</subject><subject>Creatinine</subject><subject>Dose equivalence</subject><subject>Drug dosages</subject><subject>Ethics</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Kidneys</subject><subject>Metaraminol</subject><subject>Noradrenaline</subject><subject>Norepinephrine</subject><subject>Patients</subject><subject>Ratios</subject><subject>Retrospective Studies</subject><subject>Sepsis</subject><subject>Sepsis - complications</subject><subject>Vasodilatory shock</subject><subject>Ventilators</subject><issn>0883-9441</issn><issn>1557-8615</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</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>eNp9kM1O3DAUhS1U1BmgL8CiitRNNxl8_ReP1A2iQJGQ2MDacpwbyVESD3YyEru-Q9-QJ6mHGVh00dXdfOfo3I-Qc6AroKAuulXnolsxyvgKpBCcHpElSFmVWoH8RJZUa16uhYAFOUmpoxQqzuVnsuCaCckrtSQPP0PCAp9nv7U9jg6LNsRiwMlGO_gx9IUdm2IM0TYRR9v7EYvX33-KyyLiFEPaoJv8FjNl-5fk0xk5bm2f8MvhnpKnm-vHq1_l_cPt3dXlfenygqmUEqVA5lA5dFLXbF0DtACac6ytbqpWMw5WsabFlirHBRVrzSxSzmvM20_J933vJobnGdNkBp8c9r0dMczJsDVUUkJVsYx--wftwhzz3jdKCZCKqUyxPeXyVyliazbRDza-GKBmp9t0Zqfb7HSbve4c-nqonusBm4_Iu98M_NgDmF1sPUaTnN9pbnzM5kwT_P_6_wJSm5EW</recordid><startdate>202404</startdate><enddate>202404</enddate><creator>Costa-Pinto, Rahul</creator><creator>Neto, Ary Serpa</creator><creator>Matthewman, Madeline Coxwell</creator><creator>Osrin, Dean</creator><creator>Liskaser, Grace</creator><creator>Li, Jasun</creator><creator>Young, Marcus</creator><creator>Jones, Daryl</creator><creator>Udy, Andrew</creator><creator>Warrillow, Stephen</creator><creator>Bellomo, Rinaldo</creator><general>Elsevier Inc</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>3V.</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>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>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202404</creationdate><title>Dose equivalence for metaraminol and noradrenaline – A retrospective analysis</title><author>Costa-Pinto, Rahul ; 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However, little is known of their dose equivalence.
We conducted a single centre retrospective cohort study of all ICU patients who transitioned from metaraminol to noradrenaline infusions between August 26, 2016 and December 31, 2020. Patients receiving additional vasoactive drug infusion were excluded. Dose equivalence was calculated based on the last hour metaraminol dose (in μg/min) and the first hour noradrenaline dose (in μg/min) with the closest matched mean arterial pressure (MAP). Sensitivity analyses were performed on patients with acute kidney injury (AKI), sepsis and mechanical ventilation.
We studied 195 patients. The median conversion ratio of metaraminol to noradrenaline was 12.5:1 (IQR 7.5–20.0) for the overall cohort. However, the coefficient of variation was 77% and standard deviation was 11.8. Conversion ratios were unaffected by sepsis or mechanical ventilation but increased (14:1) with AKI. One in five patients had a MAP decrease of >10 mmHg during the transition period from metaraminol to noradrenaline. Post-transition noradrenaline dose (p < 0.001) and AKI (p = 0.045) were independently associated with metaraminol dose. The proportion of variation in noradrenaline dose predicted from metaraminol dose was low (R2 = 0.545).
The median dose equivalence for metaraminol and noradrenaline in this study was 12.5:1. However, there was significant variance in dose equivalence, only half the proportion of variation in noradrenaline infusion dose was predicted by metaraminol dose, and conversion-associated hypotension was common.
•Median dose equivalence for metaraminol and noradrenaline in this study was 12.5:1•There was significant variance in dose equivalence between the two vasopressors•Only half the variation in noradrenaline could be predicted from metaraminol dose•21% of patients had a MAP decrease >10 mmHg when transitioning between vasopressors</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38245376</pmid><doi>10.1016/j.jcrc.2023.154430</doi></addata></record> |
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| subjects | Acute kidney injury Acute Kidney Injury - complications Cohort analysis Creatinine Dose equivalence Drug dosages Ethics Hemodynamics Humans Intensive care Kidneys Metaraminol Noradrenaline Norepinephrine Patients Ratios Retrospective Studies Sepsis Sepsis - complications Vasodilatory shock Ventilators |
| title | Dose equivalence for metaraminol and noradrenaline – A retrospective analysis |
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