2026 Southeastern Residency Conference

COMPARING TIME-TO-TARGET MEAN ARTERIAL PRESSURE WITH WEIGHT BASED VS. NON-WEIGHT-BASED NOREPINEPHRINE
Logan Turner, PharmD; Brian Hairston, PharmD, MBA; Allison Jolley, PharmD, BCCCP; Andrew B. Watkins, PharmD, BCIDP

FMOL Health | St. Dominic- Jackson, MS

Background/Purpose: Septic shock is a life-threatening manifestation of sepsis characterized by persistent hypotension requiring vasopressor therapy to maintain a mean arterial pressure (MAP) ≥ 65 mmHg. Norepinephrine is the first-line vasopressor recommended in current guidelines; however, there is no standardized dosing strategy, and institutions utilize either weight-based (mcg/kg/min) or fixed (mcg/min) dosing protocols. At FMOL Health | St. Dominic, practice transitioned from fixed dosing to weight-based dosing in 2022. The purpose of this study is to compare time to goal MAP between weight-based and fixed norepinephrine dosing strategies in critically ill adults with septic shock.


Methodology: This quasi-experimental, retrospective cohort study will evaluate adult ICU patients treated for septic shock during two time periods: January 1, 2019 to December 31, 2019 (fixed dosing cohort) and January 1, 2023 to December 31, 2023 (weight-based dosing cohort). Patients will be identified using electronic health record data. Eligible patients will include adults ≥ 18 years of age admitted to the ICU during the study periods with a diagnosis of septic shock requiring initiation of norepinephrine infusion to maintain a goal MAP ≥ 65 mmHg. Septic shock will be defined using clinical documentation and qSOFA criteria. Patients will be excluded if norepinephrine was initiated for indications other than septic shock, if vasopressors were started prior to ICU admission, if they are pregnant or incarcerated, or if key norepinephrine infusion data are incomplete or missing.


Results: A total of 100 patients were included, with 50 patients in each group. There was no significant difference in median time to target MAP between the weight-based and non-weight-based groups (41 vs 46 minutes; p = 0.73). Weight-based dosing was associated with significantly higher initial and maximum norepinephrine infusion rates. No statistically significant differences were observed in secondary outcomes, including AKI, mortality, or ICU length of stay.


Conclusions: Weight-based norepinephrine dosing did not improve time to target MAP and resulted in higher infusion rates without clear clinical benefit, suggesting no advantage over non-weight-based dosing in patients with septic shock. Although the overall incidence of acute kidney injury did not differ between groups, patients who developed AKI in the weight-based group received higher maximum norepinephrine doses, highlighting a potential safety concern.