Effect of Detailed Titration Instructions on Time to Hemodynamic Stability in ICU Patients Requiring Norepinephrine

Background: This study was conducted to assess the effect of titration instructions on patients receiving norepinephrine. Methods: In a single-center, retrospective cohort of patients who received at least 24 hours of norepinephrine as their first vasopressor (n = 1,303), patients were classified by whether they received norepinephrine before (n = 616) or after (n = 687) titration instructions were added. Results: Patients in the two groups had significant differences at baseline. On univariate analysis, time to hemodynamic stability was significantly longer in the post group (32 minutes [interquartile range (IQR): 12-65] vs. 10 minutes [IQR: 0-26]; p < 0.01). On multivariate analysis, addition of titration instructions was associated with an increase of 24 minutes in time to hemodynamic stability after accounting for differences in baseline systolic blood pressure, fluid boluses before norepinephrine, baseline arrhythmia, and number of other vasopressors or titratable infusions (p = 0.02). Conclusion: In this evaluation, time to hemodynamic stability was significantly longer after addition of norepinephrine titration instructions even when accounting for differences in baseline characteristics.