Time to Vasopressor Initiation and Organ Failure Progression in Early Septic Shock

Overview

Journal J Am Coll Emerg Physicians Open

Publisher Elsevier

Specialty Emergency Medicine

Date 2020 Oct 1

PMID 33000037

Citations 6

Authors

Lauren Page Black

Michael A Puskarich

Carmen Smotherman

Taylor Miller

Rosemarie Fernandez

Faheem W Guirgis

Affiliations

Soon will be listed here.

Abstract

Objective: Research evaluating the relationship between vasopressor initiation timing and clinical outcomes is limited and conflicting. We investigated the association between time to vasopressors, worsening organ failure, and mortality in patients with septic shock.

Methods: This was a retrospective study of patients with septic shock (2013-2016) within 24 hours of emergency department (ED) presentation. The primary outcome was worsening organ failure, defined as an increase in Sequential Organ Failure Assessment (SOFA) score ≥2 at 48 hours compared to baseline, or death within 48 hours. The secondary outcome was 28-day mortality. Time to vasopressor initiation was categorized into 6, 4-hour intervals from time of ED triage. Multiple logistic regression was used to identify predictors of worsening organ failure.

Results: We analyzed data from 428 patients with septic shock. There were 152 patients with the composite primary outcome (SOFA increase ≥2 or death at 48 hours). Of these, 77 patients died in the first 48 hours and 75 patients had a SOFA increase ≥2. Compared to the patients who received vasopressors in the first 4 hours, those with the longest time to vasopressors (20-24 hours) had increased odds of developing worsening organ failure (odds ratios [OR] = 4.34, 95% confidence intervals [CI] = 1.47-12.79, = 0.008). For all others, the association between vasopressor timing and worsening organ failure was non-significant. There was no association between time to vasopressor initiation and 28-day mortality.

Conclusions: Increased time to vasopressor initiation is an independent predictor of worsening organ failure for patients with vasopressor initiation delays >20 hours.

Citing Articles

Extremely early initiation of vasopressors might not decrease short-term mortality for adults with septic shock: a systematic review and meta-analysis.

Ma C, Healy J, Kinteh E, Ma C, Tzeng C, Chou E Ann Intensive Care. 2025; 15(1):18.

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Early administration of multiple vasopressors is associated with better survival in patients with sepsis: a propensity score-weighted study.

Tong X, Xue X, Duan C, Liu A Eur J Med Res. 2023; 28(1):249.

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[Fluid and vasopressor therapy in sepsis].

Petros S Med Klin Intensivmed Notfmed. 2023; 118(2):163-171.

PMID: 36598519 DOI: 10.1007/s00063-022-00976-8.

Vasopressor Choice and Timing in Vasodilatory Shock.

Wieruszewski P, Khanna A Crit Care. 2022; 26(1):76.

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Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith C, French C Intensive Care Med. 2021; 47(11):1181-1247.

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