The risk of death caused by the use of norepinephrine-resistant hypotension in the condition of septic shock in a patient
Author(s):
Govind S. Shete, Bansode G. V, Shaymlila B.Bavage, Nandkishor B.Bavage
Keywords:
Abstract
Septic shock is associated with high mortality. Aged and multimorbid patients are not always eligible for intensive care units. Norepinephrine is an accepted treatment for hypotension in septic shock. It is unknown whether norepinephrine has a place in treatment outside an intensive care unit and when given peripherally To describe mortality, Acute Physiology And Chronic Health Evaluation (APACHE-II), time to mean arterial pressure >65 mmHg, and adverse events in patients with septic shock receiving norepinephrine peripherally in an intermediate care unit.From a retrospective chart review of 91 patients with septic shock treated with norepinephrine for hypotension, ward mortality, 30-, 60- and 90-day mortality, standardized mortality ratio (SMR) and adverse events (necrosis and arrhythmia) were analysed. Administration route via peripheral venous catheter or central venous catheter was registered. Despite timely intervention, there exists a small subgroup of patients with septic shock who develop progressive multi-organ failure. Seemingly refractory to conventional therapy, they exhibit a very high mortality. Such patients are often poorly represented in large clinical trials. Consequently, good evidence for effective treatment strategies is lacking. In this article, we describe a pragmatic, multi-faceted approach to managing patients with refractory septic shock based on our experience of toxin-mediated sepsis in a specialist referral centre. Many components of this strategy are inexpensive and widely accessible, and so may offer an opportunity to improve outcomes in these critically ill patients.
Article Details
Unique Paper ID: 152454

Publication Volume & Issue: Volume 8, Issue 3

Page(s): 356 - 361
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