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Table 2 Survey questions and answers on vasopressor use in septic shock

From: Current use of vasopressors 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%)