Table 2.
Survey questions and answers on vasopressor use in septic shock
| Respondents | |
|---|---|
| No (%) | |
| How do you measure arterial blood pressure in septic shock? | |
| Always invasively and continuously via an arterial line | 707 (84%) |
| Invasively only in case of severe shock | 97 (12%) |
| Mostly non-invasively and discontinuously (arm cuff) | 32 (4%) |
| Mostly non-invasively but continuously using applanation tonometry | 2 (0.3%) |
| Mostly non-invasively but continuously using finger cuff | 1 (0.1%) |
| What is your main triggering factor(s) for initiating a vasopressor in septic shock? | |
| A low diastolic blood pressure whatever the correction of hypovolemia | 29 (3%) |
| Insufficient cardiac output response to the initial fluid resuscitation | 56 (7%) |
| Insufficient central venous oxygen saturation response to the initial fluid resuscitation | 16 (2%) |
| Insufficient mean arterial pressure response to the initial fluid resuscitation | 700 (83%) |
| Other | 38 (5%) |
| What is your first line vasopressor in the treatment of hypotension? | |
| Adrenaline/epinephrine | 4 (0.5%) |
| Dopamine | 17 (2%) |
| Noradrenaline/norepinephrine | 816 (97%) |
| Vasopressin/terlipressin | 2 (0.3%) |
| Phenylephrine | 0 (0%) |
| When do you use your vasopressor? | |
| I try to avoid any use of vasopressors and stick to volume therapy | 15 (2%) |
| I use a vasopressor early, before complete volume resuscitation (despite preload dependency) | 104 (12%) |
| I use a vasopressor only after assessment of preload dependency | 371 (44%) |
| I use a vasopressor only after completed treatment of preload dependency | 228 (27%) |
| I use a vasopressor regardless of preload dependency | 121 (14%) |
| What is your main reason for increasing the dose of the vasopressor used? | |
| Diastolic arterial pressure target not reached | 13 (2%) |
| Mean arterial pressure target not reached | 568 (68%) |
| No arterial blood pressure response to the current dose | 63 (8%) |
| Signs of organ dysfunction despite reaching the arterial blood pressure target | 173 (21%) |
| Systolic arterial pressure target not reached | 22 (3%) |
| What is your arterial blood pressure target for vasopressor therapy? | |
| A diastolic blood pressure > 40 mmHg | 12 (1%) |
| A mean arterial pressure > 60–65 mmHg | 584 (70%) |
| A mean arterial pressure > 70–75 mmHg | 207 (25%) |
| A mean arterial pressure > 80–85 mmHg | 24 (3%) |
| A systolic blood pressure > 100 mmHg | 12 (1%) |
| Which patient’s factor(s) may encourage you to increase your arterial blood pressure target? | |
| Age | 14 (2%) |
| History of chronic hypertension | 662 (79%) |
| History of coronary artery disease | 52 (6%) |
| None of them | 102 (12%) |
| Value of central venous pressure | 9 (1%) |
| When the patient does not respond to your current vasopressor therapy, what is your main reason for adding another vasopressor agent to the current therapy? | |
| A pre-defined maximum dose of the 1st choice vasopressor has been reached | 119 (14%) |
| Although the pre-defined maximum dose of the 1st choice vasopressor has not been reached, previous increases in the dose of this vasopressor were ineffective | 135 (16%) |
| By adding a second vasopressor although the pre-defined maximum dose of the 1st choice vasopressor has not been reached, I want to limit/reduce the side-effects of the first vasopressor | 173 (21%) |
| I suppose that the mechanism of action of the first vasopressor is exhausted (e.g., adrenoceptors down regulation) and want to use a second one with an independent mechanism of action | 213 (25%) |
| I want to use synergistic effects of two different mechanisms of action | 199 (24%) |
| What is your main reason for reducing or stopping vasopressor therapy? | |
| Arterial blood pressure targets have been reached | 463 (55%) |
| I am concerned by potential side effects of current vasopressor therapy | 39 (5%) |
| Side effects of current vasopressor have occurred | 15 (2%) |
| The patient’s clinical situation is improving even if the arterial blood pressure target has not been reached | 296 (35%) |
| Vasopressor treatment is futile | 26 (3%) |
| Which of the following statements fits best your opinion on norepinephrine use in the treatment of shock? | |
| Restoring mean arterial pressure with norepinephrine is usually associated with a decrease in systemic blood flow | 69 (8%) |
| Restoring mean arterial pressure with norepinephrine is usually associated with a deterioration of renal function | 9 (1%) |
| Restoring mean arterial pressure with norepinephrine is usually associated with a reduction in microcirculatory blood flow and/or tissue oxygenation | 201 (24%) |
| Restoring mean arterial pressure with norepinephrine is usually associated with an increase in systemic blood flow | 442 (53%) |
| Restoring mean arterial pressure with norepinephrine is usually associated with no change in systemic blood flow | 118 (14%) |