PURPOSE Septic shock is associated with massive release of endogenous catecholamines. Adrenergic agents may exacerbate catecholamine toxicity and contribute to poor outcomes. We sought to determine whether an association existed between tachycardia and mortality in septic shock patients requiring norepinephrine for more than 6 h despite adequate volume resuscitation. MATERIALS AND METHODS Multicentre retrospective observational study on 730 adult patients in septic shock consecutively admitted to eight European ICUs between 2011 and 2013. Three timepoints were selected: T1 (first hour of infusion of norepinephrine), Tpeak (time of highest dose during the first 24 h of treatment), and T24 (24-h post-T1). Binary logistic regression models were constructed for the three time-points. RESULTS Overall ICU mortality was 38.4%. Mortality was higher in those requiring high-dose (≥0.3 mcg/kg/min) versus low-dose (<0.3 mcg/kg/min) norepinephrine at T1 (53.4% vs 30.6%; p < 0.001) and T24 (61.4% vs 20.4%; p < 0.0001). Patients requiring high-dose with concurrent tachycardia had higher mortality at T1; in the low-dose group tachycardia was not associated with mortality. Resolving tachycardia (from T1 to T24) was associated with lower mortality compared to patients where tachycardia persisted (27.8% vs 46.4%; p = 0.001). CONCLUSIONS Use of high-dose norepinephrine and concurrent tachycardia are associated with poor outcomes in septic shock.

中文翻译：

---

去甲肾上腺素剂量，心动过速与败血性休克结局之间的关系：多中心评估。

目的败血性休克与内源性儿茶酚胺的大量释放有关。肾上腺能药可能加剧儿茶酚胺的毒性并导致不良预后。我们试图确定尽管有足够的容量复苏，但仍需要去甲肾上腺素超过6小时的败血性休克患者的心动过速与死亡率之间是否存在关联。材料与方法2011年至2013年间，对730例败血症性休克成年患者连续接受了8例欧洲ICU的多中心回顾性观察研究。选择了三个时间点：T1（去甲肾上腺素输注的第一小时），Tpeak（头24天内最大剂量的时间） h（治疗小时）和T24（T1后24小时）。针对三个时间点构建了二进制逻辑回归模型。结果ICU总体死亡率为38.4％。需要高剂量（≥0.3 mcg / kg / min）的人的死亡率高于低剂量（<0.3 mcg / kg / min）的去甲肾上腺素在T1（53.4％vs 30.6％; p <0.001）和T24（61.4％ vs 20.4％； p <0.0001）。需要大剂量并发心动过速的患者在T1时死亡率较高。低剂量组心动过速与死亡率无关。与持续性心动过速的患者相比，解决心动过速（从T1到T24）的死亡率较低（27.8％对46.4％； p = 0.001）。结论使用大剂量去甲肾上腺素和并发心动过速与败血性休克预后差有关。需要大剂量并发心动过速的患者在T1时死亡率较高。低剂量组心动过速与死亡率无关。与持续性心动过速的患者相比，解决心动过速（从T1到T24）的死亡率较低（27.8％对46.4％； p = 0.001）。结论使用大剂量去甲肾上腺素和并发心动过速与败血性休克预后差有关。需要大剂量并发心动过速的患者在T1时死亡率较高。低剂量组心动过速与死亡率无关。与持续性心动过速的患者相比，解决心动过速（从T1到T24）的死亡率较低（27.8％对46.4％； p = 0.001）。结论使用大剂量去甲肾上腺素和并发心动过速与败血性休克预后差有关。