Does Switching Norepinephrine to Phenylephrine in Septic Shock Complicated by Atrial Fibrillation With Rapid Ventricular Response Improve Time to Rate Control?

2020 ◽  
Vol 36 (2) ◽  
pp. 191-196
Author(s):  
Manuela Haiduc ◽  
Sara Radparvar ◽  
Samuel L. Aitken ◽  
Jerry Altshuler
Keyword(s):  
Atrial Fibrillation ◽  
Septic Shock ◽  
Length Of Stay ◽  
Rate Control ◽  
Clinical Effect ◽  
Hazard Ratio ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
End Point ◽  
Ventricular Response

Background: Atrial fibrillation (AF) frequently develops during critical illness. In septic shock complicated by rapid AF, the use of phenylephrine may be advantageous secondary to its β-1 sparing properties. However, evidence supporting this strategy is lacking. Objective: The purpose of this study is to determine the clinical effect on rate control of transitioning norepinephrine to phenylephrine in septic shock patients who develop AF with a rapid ventricular response (RVR). Methods: A single-center retrospective study of septic shock patients admitted to the medical or surgical intensive care unit (ICU) who developed AF with RVR (heart rate >110 beats per minute [bpm]). Patients who were switched to phenylephrine were compared to those who remained on norepinephrine. The primary end point was sustained achievement of rate control. A time-varying Cox proportional hazards model was used to assess the primary end point. Results: A total of 67 patients were included in the study, of which 28 were switched to phenylephrine. Baseline characteristics were similar between groups. The unadjusted hazard ratio for achieving rate control was significant at 1.99 (95% confidence interval [CI]: 1.19-3.34; P < .01) for the phenylephrine group. The adjusted hazard ratio was 1.75 (95% CI: 0.86-3.53; P = .12). There were no statistically significant differences in mortality or ICU length of stay. Conclusion: Our study suggests a potential clinical effect on achieving rate control when switching to phenylephrine cannot be excluded. It remains unclear if there is a benefit on mortality or length of stay outcomes in critically ill patients.

Evaluation of Amiodarone Use for New-Onset Atrial Fibrillation in Critically Ill Patients With Septic Shock

2019 ◽  
pp. 001857871986840
Author(s):  
Kevin D. Betthauser ◽  
Gabrielle A. Gibson ◽  
Shannon L. Piche ◽  
Hannah E. Pope
Keyword(s):  
Atrial Fibrillation ◽  
Septic Shock ◽  
Sensitivity Analysis ◽  
Critically Ill ◽  
Hospital Length Of Stay ◽  
Surgical Intensive Care Unit ◽  
Apache Ii Score ◽  
Surgical Intensive Care ◽  
Onset Atrial Fibrillation ◽  
New Onset

Objective: To describe the use of amiodarone in critically ill, septic shock patients experiencing new-onset atrial fibrillation (NOAF) during the acute resuscitative phase of septic shock. Methods: Single-center, retrospective review of adult medical or surgical intensive care unit (ICU) patients with septic shock and NOAF. All patients received amiodarone for NOAF during the acute resuscitative phase of septic shock. The cohort was analyzed via descriptive statistics. Associations between amiodarone exposure and clinical outcomes were analyzed via a Cox proportional-hazards model. An a priori defined sensitivity analysis of hospital survivors was also employed. Main Results: A total of 239 patients were included in the analysis. Patients had a median baseline Charlson Comorbidity Index of 4 (interquartile range [IQR]: 2-6) and were acutely ill with a median Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 18 (IQR: 13-22) and an incidence of mechanical ventilation of 85%. In-hospital mortality was 56% with median ICU and hospital length of stay (LOS) of 9 and 15 days, respectively. Included patients received a median of 2760 (IQR: 1110-6415) mg of intravenous (IV) amiodarone during their ICU stay. Receipt of more than or equal to 2700 mg of amiodarone was identified as an independent factor associated with longer ICU LOS (hazard ratio [HR]: 1.30; 95% confidence interval [CI], 1.10-2.28). In a sensitivity analysis of hospital survivors (n = 105), receipt of more than or equal to 2700 mg of amiodarone remained independently associated with longer ICU LOS (HR: 1.64; 95% CI, 1.05-2.58). Conclusions: Exposure to more than or equal to 2700 mg of amiodarone in the setting of NOAF and septic shock is positively correlated with longer ICU LOS. Identifying opportunities to limit amiodarone exposure and address/resolve potential precipitating causes of NOAF in this clinical scenario may reduce the morbidity associated with septic shock.

The surgical intensive care unit optimal mobility score predicts mortality and length of stay*

2012 ◽  
Vol 40 (4) ◽  
pp. 1122-1128 ◽  
Author(s):  
George Kasotakis ◽  
Ulrich Schmidt ◽  
Dana Perry ◽  
Martina Grosse-Sundrup ◽  
John Benjamin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Mobility Score

Rate versus rhythm control therapy for atrial fibrillation

2018 ◽  
Author(s):  
Albert L. Waldo
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Control Strategy ◽  
Rate Control ◽  
Anticoagulation Therapy ◽  
Rhythm Control ◽  
Rate Versus ◽  
Ventricular Response ◽  
Tachycardia Induced Cardiomyopathy ◽  
Stable Sinus Rhythm

Based on data from several clinical trials, either rate control or rhythm control is an acceptable primary therapeutic strategy for patients with atrial fibrillation. However, since atrial fibrillation tends to recur no matter the therapy, rate control should almost always be a part of the treatment. If a rhythm control strategy is selected, it is important to recognize that recurrence of atrial fibrillation is common, but not clinical failure per se. Rather, the frequency and duration of episodes, as well as severity of symptoms during atrial fibrillation episodes should guide treatment decisions. Thus, occasional recurrence of atrial fibrillation despite therapy may well be clinically acceptable. However, for some patients, rhythm control may be the only strategy that is acceptable. In short, for most patients, either a rate or rhythm control strategy should be considered. However, for all patients, there are two main goals of therapy. One is to avoid stroke and/or systemic embolism, and the other is to avoid a tachycardia-induced cardiomyopathy. Also, because of the frequency of atrial fibrillation recurrence despite the treatment strategy selected, patients with stroke risks should receive anticoagulation therapy despite seemingly having achieved stable sinus rhythm. For patients in whom a rate control strategy is selected, a lenient approach to the acceptable ventricular response rate is a resting heart rate of 110 bpm, and probably 90 bpm. The importance of achieving and maintaining sinus rhythm in patients with atrial fibrillation and heart failure remains to be clearly established.

CHANGES IN VASOPRESSIN USE AND OUTCOMES IN SURGICAL INTENSIVE CARE UNIT PATIENTS WITH SEPTIC SHOCK

CHEST Journal ◽  
2007 ◽  
Vol 132 (4) ◽  
pp. 556B
Author(s):  
Monica I. Lupei ◽  
Gregory J. Beilman ◽  
Jeffrey G. Chipman ◽  
Henry J. Mann
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care

AMIODARONE FOR CONVERSION OF NEW-ONSET ATRIAL FIBRILLATION IN THE SURGICAL INTENSIVE CARE UNIT

2004 ◽  
Vol 32 (Supplement) ◽  
pp. A169
Author(s):  
Bruce W Neale ◽  
Jill A Rebuck ◽  
Mark Hamlin ◽  
Brian Marden ◽  
Bill Charash ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Onset Atrial Fibrillation ◽  
New Onset
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