Key result
High doses of catecholamines (>100 microg/min) in adult ICU patients resulted in a hospital survival rate of 6.25% (95% CI 0.3-12.2%).
Cohort (n=64)
No
Survival of patients requiring high doses of catecholamines (>100 microg/min) is poor (6.25%) but not entirely futile, suggesting individualized decision-making is necessary.
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Low survival with high-dose catecholamines signals grave prognosis; leaves open optimal vasopressor thresholds in refractory shock.
The aim of this study was to determine the hospital survival of patients receiving high doses of catecholamines. A retrospective observational study was conducted in a 22-bed multidisciplinary adult intensive care unit of a tertiary referral university hospital. All patients (n = 64) receiving > 100 microg/min of adrenaline or noradrenaline or adrenaline and noradrenaline combined over a one-year period were studied to determine survival to intensive care unit and hospital discharge. Four patients survived to intensive care unit discharge and hospital discharge (6.25%, 95% CI 0.3 to 12.2%). Survival was 3.3% (95% CI 0 to 7.9%) in the subgroup of 60 patients who received > 100 microg/min noradrenaline and 3.6% (95% CI 0 to 8.6%) in the 55 patients who received > 2 microg/kg/min noradrenaline. None of the 32 patients who received > 200 microg/min noradrenaline survived. We conclude that the survival of patients requiring high doses of catecholamines is poor but the use of such doses is probably not futile. It remains for individual clinicians, patients and their surrogates to decide whether use of high doses of vasopressor is appropriate, given the low probability of survival.
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Jenkins et al. (2009) conducted a cohort in Critical illness requiring high doses of catecholamines (n=64). High doses of catecholamines (> 100 microg/min of adrenaline and/or noradrenaline) was evaluated on Survival to intensive care unit and hospital discharge (95% CI 0.3-12.2). High doses of catecholamines (>100 microg/min) in adult ICU patients resulted in a hospital survival rate of 6.25% (95% CI 0.3-12.2%).
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