(1640) Comparing the Efficacy of Weight-Based and Non-Weight-Based Dosing of Norepinephrine in Septic Shock

Introduction: Norepinephrine (NE) is a sympathomimetic amine derived from the amino acid tyrosine. It is predominately used as a first line agent for hypotension that is unresponsive to fluid therapy because of its ability to act as a peripheral vasoconstrictor. Currently, there are no guideline recommendations on whether weight-based dosing (WBD) of NE or non-weight based dosing (non-WBD) of NE should be utilized.

Methods: This is a retrospective chart review of patients who received WBD NE and patients who received non-WBD NE at University Health Truman Medical Center and Lakewood Medical Center in Kansas City, Missouri. The timeframe of study is March 2022 to January 2023 for the WBD group and March 2023 to November 2023 for the non-WBD group. The primary objective is to compare the dose of NE that is needed to achieve patient specific mean arterial pressure (MAP) goal between WBD vs. non-WBD in critically ill patients. Secondary objectives include: ICU length of stay, mortality rate, time to second vasopressor, time to patient specific MAP, and duration of NE therapy. Categorical variables were compared using Fisher’s exact or chi-squared tests.

Results: A total of 143 patients were assessed, 73 were included in the WBD group vs. 70 in the non-WBD group. The results of this study found no statistically significant differences between groups regarding the primary outcome which was the the dose of NE that is needed to achieve patient specific MAP goal (p = 0.692). Of the secondary outcomes, the only statistically significant finding was time to patient specific MAP goal which was found to be around 2.8 hours earlier in the Non-WBD group (p = 0.034).

Conclusions: There was no difference between WBD and Non-WBD NE on the primary outcome; however, time to patient specific MAP goal was shorter with Non-WBD and other secondary outcomes may favor Non-WBD dosing.