Comparison of Two Titration Methods of Vasopressor Infusion to Correct Septic Shock

ABSTRACT

BACKGROUND: Administration of a vasopressor is frequently required in treating septic shock. The conventional method of vasopressor infusion, which includes incremental titration of a vasopressor to raise blood pressure, is sometimes a time-consuming process that might prolong the duration of the shock. PURPOSE: This study was to evaluate whether a method of vasopressor infusion that starts from an acceptable maximal dose has advantages over a method of vasopressor infusion that starts from a low dose in patients with septic shock. SUBJECTS AND METHODS: Twenty-five patients with septic shock, which was not corrected with fluid resuscitation of 20~30 ml/kg, were randomized into two groups. The patients in the low-to-high group (n=13) received a vasopressor in an incremental manner starting from a low dose. The patients in the high-to-low group (n=12) received a vasopressor in a decremental manner starting from an acceptable maximal dose. The shock durations (time from the beginning of vasopressor infusion to correction of the shock), and the hemodynamic and metabolic parameters, including blood pressure, pulse rate, arterial lactate concentration, anion gap, base excess, and central venous oxygen saturation, before vasopressor infusion, and 2, 4, 6, 12, and 24 hours after vasopressor infusion were compared for the two groups. The length of ICU stay, the length of total hospital stay, the type of discharge, and the survival rate were also compared. RESULTS: The shock duration was shorter in the high-to-low group than in the low-to-high group (14.7+/-21 min. vs 41.9 +/-41 min., p=0.01). There were no differences between the two groups as to hemodynamic and metabolic parameters. The ICU stay was shorter in the high-to-low group than in the low-to-high group (7+/-7 days vs 10+/-22 days); however, the difference did not reach statistical significance (p=0.934). CONCLUSION: The method of vasopressor infusion starting from acceptable maximal dose shortens the duration of shock compared to the conventional incremental titration method.