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An updated “norepinephrine equivalent” score in intensive care as a marker of shock severity

Vasopressors and fluids are the cornerstones for the treatment of shock. The current international guidelines on shock recommend norepinephrine as the first-line vasopressor and vasopressin as the second-line vasopressor. In clinical practice, due to drug availability, local practice variations, spe...

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Autores principales: Kotani, Yuki, Di Gioia, Annamaria, Landoni, Giovanni, Belletti, Alessandro, Khanna, Ashish K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9854213/
https://www.ncbi.nlm.nih.gov/pubmed/36670410
http://dx.doi.org/10.1186/s13054-023-04322-y
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author Kotani, Yuki
Di Gioia, Annamaria
Landoni, Giovanni
Belletti, Alessandro
Khanna, Ashish K.
author_facet Kotani, Yuki
Di Gioia, Annamaria
Landoni, Giovanni
Belletti, Alessandro
Khanna, Ashish K.
author_sort Kotani, Yuki
collection PubMed
description Vasopressors and fluids are the cornerstones for the treatment of shock. The current international guidelines on shock recommend norepinephrine as the first-line vasopressor and vasopressin as the second-line vasopressor. In clinical practice, due to drug availability, local practice variations, special settings, and ongoing research, several alternative vasoconstrictors and adjuncts are used in the absence of precise equivalent doses. Norepinephrine equivalence (NEE) is frequently used in clinical trials to overcome this heterogeneity and describe vasopressor support in a standardized manner. NEE quantifies the total amount of vasopressors, considering the potency of each such agent, which typically includes catecholamines, derivatives, and vasopressin. Intensive care studies use NEE as an eligibility criterion and also an outcome measure. On the other hand, NEE has several pitfalls which clinicians should know, important the lack of conversion of novel vasopressors such as angiotensin II and also adjuncts such as methylene blue, including a lack of high-quality data to support the equation and validate its predictive performance in all types of critical care practice. This review describes the history of NEE and suggests an updated formula incorporating novel vasopressors and adjuncts.
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spelling pubmed-98542132023-01-21 An updated “norepinephrine equivalent” score in intensive care as a marker of shock severity Kotani, Yuki Di Gioia, Annamaria Landoni, Giovanni Belletti, Alessandro Khanna, Ashish K. Crit Care Perspective Vasopressors and fluids are the cornerstones for the treatment of shock. The current international guidelines on shock recommend norepinephrine as the first-line vasopressor and vasopressin as the second-line vasopressor. In clinical practice, due to drug availability, local practice variations, special settings, and ongoing research, several alternative vasoconstrictors and adjuncts are used in the absence of precise equivalent doses. Norepinephrine equivalence (NEE) is frequently used in clinical trials to overcome this heterogeneity and describe vasopressor support in a standardized manner. NEE quantifies the total amount of vasopressors, considering the potency of each such agent, which typically includes catecholamines, derivatives, and vasopressin. Intensive care studies use NEE as an eligibility criterion and also an outcome measure. On the other hand, NEE has several pitfalls which clinicians should know, important the lack of conversion of novel vasopressors such as angiotensin II and also adjuncts such as methylene blue, including a lack of high-quality data to support the equation and validate its predictive performance in all types of critical care practice. This review describes the history of NEE and suggests an updated formula incorporating novel vasopressors and adjuncts. BioMed Central 2023-01-20 /pmc/articles/PMC9854213/ /pubmed/36670410 http://dx.doi.org/10.1186/s13054-023-04322-y Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Perspective
Kotani, Yuki
Di Gioia, Annamaria
Landoni, Giovanni
Belletti, Alessandro
Khanna, Ashish K.
An updated “norepinephrine equivalent” score in intensive care as a marker of shock severity
title An updated “norepinephrine equivalent” score in intensive care as a marker of shock severity
title_full An updated “norepinephrine equivalent” score in intensive care as a marker of shock severity
title_fullStr An updated “norepinephrine equivalent” score in intensive care as a marker of shock severity
title_full_unstemmed An updated “norepinephrine equivalent” score in intensive care as a marker of shock severity
title_short An updated “norepinephrine equivalent” score in intensive care as a marker of shock severity
title_sort updated “norepinephrine equivalent” score in intensive care as a marker of shock severity
topic Perspective
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9854213/
https://www.ncbi.nlm.nih.gov/pubmed/36670410
http://dx.doi.org/10.1186/s13054-023-04322-y
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