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Original Research: Critical Care |

Survival After Shock Requiring High-Dose Vasopressor TherapyShock Requiring High-Dose Vasopressor Therapy

Samuel M. Brown, MD; Michael J. Lanspa, MD; Jason P. Jones, PhD; Kathryn G. Kuttler, PhD; Yao Li, MStat; Rick Carlson, PharmD; Russell R. Miller, III, MD, MPH; Eliotte L. Hirshberg, MD; Colin K. Grissom, MD, FCCP; Alan H. Morris, MD, FCCP
Author and Funding Information

From the Pulmonary and Critical Care Medicine (Drs Brown, Lanspa, Kuttler, Miller, Hirshberg, Grissom, and Morris and Ms Li), Homer Warner Center for Informatics Research (Dr Kuttler), Department of Pharmacy (Dr Carlson), Intermountain Medical Center, Murray, UT; Pulmonary and Critical Care Medicine (Drs Brown, Lanspa, Miller, Hirshberg, Grissom, and Morris), Division of Pediatric Critical Care (Dr Hirshberg), University of Utah School of Medicine, Salt Lake City, UT; and Research and Evaluation (Dr Jones), Kaiser-Permanente Southern California, Pasadena, CA.

Correspondence to: Samuel M. Brown, MD, Shock Trauma ICU, Intermountain Medical Center, 5121 S. Cottonwood St, Murray, UT 84107.


Funding/Support: This research was supported by the US National Institutes of Health/National Institute of General Medical Sciences [Grant K23GM094465 to Dr Brown]; the Intermountain Research and Medical Foundation; and the Easton Family Fund.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(3):664-671. doi:10.1378/chest.12-1106
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Background:  Some patients with hypotensive shock do not respond to usual doses of vasopressor therapy. Very little is known about outcomes after high-dose vasopressor therapy (HDV). We sought to characterize survival among patients with shock requiring HDV. We also evaluated the possible utility of stress-dose corticosteroid therapy in these patients.

Methods:  We conducted a retrospective study of patients with shock requiring HDV in the ICUs of five hospitals from 2005 through 2010. We defined HDV as receipt at any point of ≥ 1 μg/kg/min of norepinephrine equivalent (calculated by summing norepinephrine-equivalent infusion rates of all vasopressors). We report survival 90 days after hospital admission. We evaluated receipt of stress-dose corticosteroids, cause of shock, receipt of CPR, and withdrawal or withholding of life support therapy.

Results:  We identified 443 patients meeting inclusion criteria. Seventy-six (17%) survived. Survival was similar (20%) among the 241 patients with septic shock. Among the 367 nonsurvivors, 254 (69%) experienced withholding/withdrawal of care, and 115 (31%) underwent CPR. Stress-dose corticosteroid therapy was associated with increased survival (P = .01).

Conclusions:  One in six patients with shock survived to 90 days after HDV. The majority of nonsurvivors died after withdrawal or withholding of life support therapy. A minority of patients underwent CPR. Additionally, stress-dose corticosteroid therapy appears reasonable in patients with shock requiring HDV.

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