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Catecholamine Dosing and Survival in Adult Intensive Care Unit Patients

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Abstract

Background

Volume management and vasopressor support remain the gold standard of critical care for patients with shock. However, prolonged therapy with catecholamines in high doses is associated with a negative patient outcome. The aim of the present study was to analyze the administered levels of catecholamines over time with respect to survival, and to identify a cut-off to allow a prediction of survival.

Methods

Consecutively, 9,108 adult patients during 22 months were evaluated. This group included 1,543 patients treated with epinephrine and/or norepinephrine with any dose at any time. Time and dosages of the applied drugs, the sequential organ failure assessment and acute and chronic health evalutation II scores on admission and daily, the length of intensive care unit stay, and the outcomes were recorded.

Results

The non-survivors received higher doses of norepinephrine and epinephrine than the survivors (p < 0.001). The receiver operator characteristic curve for the area under the curve with non-survival as the classifier revealed a cut-off level of 294.33 μg/kg for norepinephrine with a sensitivity of 74.73 % and a specificity of 70.48 % and a cut-off for epinephrine of 70.36 μg/kg with a sensitivity of 83.87 % and a specificity of 72.79 %. Dose-dependent time curves using these cut-off values were calculated.

Conclusions

Survival of patients with prolonged therapy with norepinephrine and epinephrine above the evaluated thresholds is poor, whereas short-term application of high-dose catecholamines is not associated with poor outcome. Therefore, it remains for the individual clinician, patients, and their surrogates to decide whether the use of high doses of vasopressors is appropriate in view of the low probability of survival.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Marc Kastrup, Jan Braun & Claudia Spies

  2. Department of General, Visceral, and Transplantation Surgery, Campus Virchow-Klinikum, Universitätsmedizin Berlin, Berlin, Germany

    Magnus Kaffarnik

  3. Klinikum Großhadern, LMU München, Marchioninistrasse 15, 81377, Munich, Germany

    Vera von Dossow-Hanfstingl

  4. IT-Department Charité-University Medicine-Berlin, Berlin, Germany

    Robert Ahlborn

  5. Institute for Biometrics and Clinical Epidemiology, Charité-University Medicine Berlin and Sostana GmbH, Berlin, Germany

    Klaus-D Wernecke

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  1. Marc Kastrup
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  2. Jan Braun
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  3. Magnus Kaffarnik
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  4. Vera von Dossow-Hanfstingl
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  5. Robert Ahlborn
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  6. Klaus-D Wernecke
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  7. Claudia Spies
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Correspondence to Claudia Spies.

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Kastrup, M., Braun, J., Kaffarnik, M. et al. Catecholamine Dosing and Survival in Adult Intensive Care Unit Patients. World J Surg 37, 766–773 (2013). https://doi.org/10.1007/s00268-013-1926-8

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  • DOI: https://doi.org/10.1007/s00268-013-1926-8

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