Hemodynamics, fluids & transfusion
Dose equivalence for metaraminol and noradrenaline – A retrospective analysis
Authors' conclusion
The median dose equivalence for metaraminol and noradrenaline in this study was 12.5:1. However, there was significant variance in dose equivalence, only half the proportion of variation in noradrenaline infusion dose was predicted by metaraminol dose, and conversion-associated hypotension was common.
Study context
- Population
- ICU patients who transitioned from metaraminol to noradrenaline infusions, August 26, 2016 to December 31, 2020, without additional vasoactive drug infusion
- Participants
- 195 patients
- Exposure
- Metaraminol to noradrenaline transition
- Outcome
- Dose equivalence (conversion ratio) of last-hour metaraminol dose to first-hour noradrenaline dose (μg/min) at closest matched MAP
Methodological detailssingle centre
- Single centre
Main finding
As reported in the abstract
Median conversion ratio (IQR 7.5-20.0), overall cohort
12.5:1
Coefficient of variation
77%
Standard deviation
11.8
Observational data: associations, not effects.
Further findings
Conversion ratio in acute kidney injury (AKI), sepsis and mechanical ventilation (sensitivity analyses)
- Increased with AKI
- 14:1
- Unaffected by sepsis or mechanical ventilation
Factors independently associated with metaraminol dose
- Post-transition noradrenaline dose
- P < 0.001
- AKI
- P = 0.045
Proportion of variation in noradrenaline dose predicted from metaraminol dose
- R2 (low)
- 0.545
Safety
Mean arterial pressure (MAP) decrease >10 mmHg during transition
- One in five patients
Original publication
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