Shock treatment in a cohort of Scandinavian intensive care units in 2014

TY - JOUR

T1 - Shock treatment in a cohort of Scandinavian intensive care units in 2014

AU - Kollind, M

AU - Wickbom, F

AU - Wilkman, E

AU - Snäckestrand, M S C

AU - Holmén, A

AU - Oldner, A

AU - Perner, A

AU - Åneman, A

AU - Chew, M S

AU - Scandinavian Critical Care Trials Group

N1 - © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - BACKGROUND: Shock is common in intensive care units, and treatment includes fluids, vasopressor and/or inotropic drugs, guided by hemodynamic monitoring. The aim of this study was to identify current practice for treatment of shock in Scandinavian intensive care units.METHODS: Seven-day inception cohort study in 43 intensive care units in Scandinavia. Patients ≥ 15 years old receiving more than 4 h of cardiovascular acting drug infusion were included. The use of fluids, vasopressor and inotropic drugs, type of monitoring, and target values were recorded.RESULTS: One hundred and seventy-one patients were included. At inclusion, 136/168 (81%) had received vasopressor and/or inotropic drug therapy for less than 24 h, and 143/171 (84%) had received volume loading before the onset of vasoactive drug treatment. Ringer's solution was given to 129/143 (90%) of patients and starches in 3/143 (2%) patients. Noradrenaline was the most commonly used cardiovascular acting drug, given in 168/171 (98%) of cases while dopamine was rarely used. Mean arterial pressure was considered the most important variable for hemodynamic monitoring. Invasive arterial blood pressure was monitored in 166/171 (97%) of patients, arterial pulse wave analysis in 11/171 (7%), and echocardiography in 50/171 (29%).CONCLUSION: In this survey, Ringer's solution and noradrenaline were the most common first-line treatments in shock. The use of starches and dopamine were rare. Almost all patients were monitored with invasive arterial blood pressure, but comprehensive hemodynamic monitoring was used only in a minority of patients.

AB - BACKGROUND: Shock is common in intensive care units, and treatment includes fluids, vasopressor and/or inotropic drugs, guided by hemodynamic monitoring. The aim of this study was to identify current practice for treatment of shock in Scandinavian intensive care units.METHODS: Seven-day inception cohort study in 43 intensive care units in Scandinavia. Patients ≥ 15 years old receiving more than 4 h of cardiovascular acting drug infusion were included. The use of fluids, vasopressor and inotropic drugs, type of monitoring, and target values were recorded.RESULTS: One hundred and seventy-one patients were included. At inclusion, 136/168 (81%) had received vasopressor and/or inotropic drug therapy for less than 24 h, and 143/171 (84%) had received volume loading before the onset of vasoactive drug treatment. Ringer's solution was given to 129/143 (90%) of patients and starches in 3/143 (2%) patients. Noradrenaline was the most commonly used cardiovascular acting drug, given in 168/171 (98%) of cases while dopamine was rarely used. Mean arterial pressure was considered the most important variable for hemodynamic monitoring. Invasive arterial blood pressure was monitored in 166/171 (97%) of patients, arterial pulse wave analysis in 11/171 (7%), and echocardiography in 50/171 (29%).CONCLUSION: In this survey, Ringer's solution and noradrenaline were the most common first-line treatments in shock. The use of starches and dopamine were rare. Almost all patients were monitored with invasive arterial blood pressure, but comprehensive hemodynamic monitoring was used only in a minority of patients.

KW - Cohort Studies

KW - Humans

KW - Intensive Care Units

KW - Monitoring, Physiologic

KW - Shock

KW - Vasoconstrictor Agents

U2 - 10.1111/aas.12745

DO - 10.1111/aas.12745

M3 - Journal article

C2 - 27291070

SN - 0001-5172

VL - 60

SP - 945

EP - 957

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 7

ER -