2025 Southeastern Residency Conference

Title: Time-to-Target Mean Arterial Pressure: Weight-Based versus Non-Weight-Based Norepinephrine in Critically Ill Patients with Septic Shock
 
Authors: Kristen Wardell, Pharm.D., Brian Hairston, MBA, Pharm.D., Katie Schipper, Pharm.D., BCCCP, Jamie Wagner, Pharm.D., BCIDP
 
Objective: To determine if there is a difference in time-to-target mean arterial pressure of critically ill patients with septic shock on weight-based norepinephrine dosing or non-weight-based dosing.
 
Background: The optimal norepinephrine dosing strategy, weight-based vs. non-weight-based, in septic shock remains controversial with no clear consensus in current guidelines.  St. Dominic Jackson-Memorial Hospital has historically utilized non-weight-based dosing (non-WBD) but transitioned to weight-based dosing (WBD) in May 2022. However, WBD may lead to excessively high doses in obese patients, which can oversaturate adrenergic receptors. These doses may also cause an increased risk of adverse effects, such as peripheral ischemia and acute kidney injury. The impact of this transition on clinical outcomes remains unclear.
 
Methods: This quasi-experimental study included adult patients admitted to St. Dominic Jackson-Memorial Hospital from January 1, 2019, to December 31, 2019, and from January 1, 2023, to December 31, 2023, who required intravenous norepinephrine for presumed septic shock. Patients were identified via electronic surveillance software. Inclusion criteria were age ≥18 years, hospital admission within the specified study periods, and norepinephrine administration. Exclusion criteria included norepinephrine duration <1 hour, prior administration of another vasopressor, norepinephrine use for non-septic shock indications, or COVID-19 diagnosis during admission. Collected data included baseline demographics, quick Sepsis-Related Organ Failure Assessment (qSOFA) score, Glasgow Coma Scale (GCS) score, initial laboratory parameters (serum lactate, creatinine, bilirubin, platelet count, white blood cell count), ventilator status, oxygenation parameters (partial pressure of oxygen [PaO₂]/fraction of inspired oxygen [FiO₂]), first and last recorded intensive care unit (ICU) mean arterial pressure (MAP), and norepinephrine dose at goal MAP.
The primary outcome of this study was the time (in minutes) to achieve the goal MAP. Secondary outcomes included duration of norepinephrine therapy, ICU length of stay, development of an acute kidney injury (AKI), in-hospital mortality within 30 days of norepinephrine initiation, and norepinephrine dose at the initiation of an additional vasopressor or stress-dose steroids. 
 
Results: In progress.
 
Conclusion: In progress.