Wieruszewski et al identified predictors of cardiac dysrhythmias for a patient receiving norepinephrine for septic shock. The authors are from the Mayo Clinic, Methodist University Hospital (Memphis), and the University of Tennessee.
Patient selection: septic shock, treated with norepinephrine
Exclusion: presence of dysrhythmia before starting norepinephrine
Dysrhythmias included:
(1) sinus tachycardia
(2) atrial flutter
(3) atrial fibrillation
(4) bradycardia
(5) supraventricular tachycardia
(6) ventricular fibrillation
Predictors of cardiac dysrhythmias:
(1) higher norepinephrine dose (mean dose 35 µg/min vs 15; OR 1.06 per 5 µg/min)
(2) longer duration of norepinephrine therapy (mean 51 hours vs 33; OR 1.007 per hour)
(3) add-on therapy with vasopressin or phenylephrine
The occurrence of cardiac dysrhythmia is associated with increased mortality.
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