An article in Crit_Care reviews the evolution of norepinephrine equivalent as a marker of shock severity in intensive care and suggests an updated formula incorporating novel vasopressors and adjuncts.
ratio as a measure of oxygenation, MAP/NEE can be used as a measure of vasopressor responsiveness and severity of shock.NEE has several pitfalls. First, with scarce evidence, the conversion ratio for each vasopressor agent is determined arbitrarily, either comparing the dose needed to achieve a target MAP or estimating the reduction in norepinephrine dose when used in combination. This drawback is especially important given the recent evidence supporting a multimodal vasopressor approach [].
Second, NEE may sometimes not reflect the total amount of hemodynamic support. Since NEE only considers vasopressor effects, NEE fails to measure the effect of other hemodynamic interventions, such as mechanical circulatory support and drugs with predominantly inotropic profiles. For example, consider a patient with severe low cardiac output syndrome who receives veno-arterial extracorporeal membrane support and moderate to a high dose of inotropes in addition to low-dose norepinephrine.
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