Res Rev J Hosp Clin Pharm. 2016 May;2(2):87-91. Epub 2016 May 12.
Impact of Norepinephrine Shortage on Outcomes in Patients with Septic Shock.
Research & reviews. Journal of hospital and clinical pharmacy
Jean M Nappi, Adam Sieg, Tanna B Hassig, Amy E Wahlquist
Affiliations
Affiliations
- College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina, USA.
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina, USA.
- Department of Pharmacy Services, Memorial Hermann-Texas Medical Center, Houston, Texas, USA.
- Department of Public Health, Medical University of South Carolina, Charleston, South Carolina, USA.
PMID: 28804796
PMCID: PMC5553972
Abstract
PURPOSE: With the previous norepinephrine shortage, alternative agents were required to treat patients with septic shock. This retrospective study evaluated whether the shortage of norepinephrine had an adverse effect on patients admitted to the intensive care unit with a diagnosis of severe sepsis or septic shock.
METHODS: This was a retrospective chart review, which compared patients who received norepinephrine versus those who did not. Eligible patients were those ≥ 18 years old who were admitted to an intensive care unit with a diagnosis of sepsis and were initiated on a vasopressor to maintain hemodynamic stability. The specific primary endpoint was whether using norepinephrine versus other vasopressors had an effect on ICU length of stay. Secondary outcomes included mortality, blood pressure, mean arterial pressure, development of renal insufficiency, and vasopressor requirements.
RESULTS: There were 288 patients screened and 214 patients who met the inclusion criteria (norepinephrine group=106 and nonnorepinephrine group=108). After accounting for potential differences in disease severity (APACHE II score), age, weight and gender, there was no difference in ICU length of stay (p=0.4); however, the odds of survival were 5.9 (95% CI: 3.1 to 11.1) times higher for those in the non-norepinephrine group (p<0.0001).
CONCLUSION: Based on this retrospective analysis, patients that did not receive norepinephrine had a similar ICU LOS but had a higher rate of survival. The norepinephrine shortage did not have an adverse effect on patient outcomes.
Conflict of interest statement
CONFLICTS OF INTEREST Dr. Nappi has received honoraria from Expert Exchange-Practice Point Communications and the Pharmacy Learning Network. Dr. Sieg and Dr. Hassig have no conflicts to disclose.
References
- Am J Health Syst Pharm. 2004 Oct 1;61(19):2015-22 - PubMed
- Crit Care Med. 1982 Jul;10(7):432-5 - PubMed
- Crit Care Med. 2008 Jan;36(1):296-327 - PubMed
- N Engl J Med. 2008 Feb 28;358(9):877-87 - PubMed
- N Engl J Med. 2010 Mar 4;362(9):779-89 - PubMed
- Crit Care Med. 2012 Mar;40(3):725-30 - PubMed
- Crit Care Med. 2006 Mar;34(3):589-97 - PubMed
- Crit Care Med. 2009 Mar;37(3):811-8 - PubMed
- Am J Health Syst Pharm. 2011 Oct 1;68(19):1811-9 - PubMed
- Crit Care Med. 1999 Mar;27(3):639-60 - PubMed
- Cancer. 2012 Jan 15;118(2):289-91 - PubMed
- Intensive Care Med. 2006 Nov;32(11):1782-9 - PubMed
- Crit Care Med. 2003 Jun;31(6):1659-67 - PubMed
- Intensive Care Med. 2008 Dec;34(12):2226-34 - PubMed
- Crit Care Med. 2013 Feb;41(2):580-637 - PubMed
- Crit Care. 2008;12(6):R143 - PubMed
- Crit Care Med. 1985 Oct;13(10):818-29 - PubMed
Publication Types
Grant support
