Time to Lose the Weight? Comparison of Weight-based and Non-weight-based Vasopressors for Septic Shock
Time to Lose the Weight? Comparison of Weight-based and Non-weight-based Vasopressors for Septic Shock
At present, there is conflicting evidence regarding outcomes in patients with septic shock
 receiving weight-based vasopressor (WBVP) versus non-weight-based vasopressor (NWBVP) dosing
 strategies. At MCMC, a weight-based strategy is in place whereas MDMC, MMMC and MRMC
 currently utilize a non-weight-based dosing strategy. Obese patients (BMI > 30) receiving
 either strategy may potentially be receiving substantially more or less vasopressor exposure
 compared to their non-obese (BMI < 30) counterparts. Determining total vasopressor exposure
 and assessing clinical outcomes would benefit our institution and others by providing optimal
 vasopressor dosing strategies in obese and non-obese patients. There is a difference in
 clinical outcomes between patients receiving weight-based and non-weight-based vasopressor
 dosing strategies. There is a difference in total vasopressor exposure between obese and
 non-obese patients utilizing WBVP and NWBVP strategies.
Vasopressors are a mainstay of therapy for patients with septic shock to achieve and maintain
 hemodynamic stability.1 Both weight-based and non-weight-based dosing recommendations exist
 with no clear evidence that one is better than the other.3-10 However, in light of the
 obesity epidemic and emerging evidence regarding the dangers of excessive catecholamine
 exposure, an evaluation of dosing practices is warranted. The aim of this study is to
 determine whether clinical outcomes differ between patients receiving weight-based and
 non-weight-based vasopressor dosing strategies for septic shock. This is a multicenter,
 retrospective chart review. Patients admitted to MDMC and MCMC from 4/1/2017-8/31/2019 will
 be identified through the electronic medical record utilizing ICD codes for sepsis and septic
 shock. Patients meeting study inclusion criteria will be analyzed as described below.
 Outcomes will be assessed between patients receiving WBVP and NWBVP with planned subgroup
 analysis in each group between patients with BMI < 30, 30-49, and > 50.
Inclusion Criteria:

 -  ICU admission

 -  Medical admission type

 -  Received NE, epinephrine (EPI), phenylephrine (PE), or dopamine (DA) for septic shock

 -  Received NE/EPI/PE/DA for > 24 hours

 -  Age ≥ 18 years

 Exclusion Criteria:

 -  Non-sepsis indication for vasopressors

 -  Surgical or trauma admission type

 -  ICU length of stay < 24 hours

 -  Pregnant