Clinical Study
A Real-World, Multicenter Assessment of Drugs Requiring Weight-Based Calculations in Overweight, Adult Critically Ill Patients
Table 1
Dosing results for vasoactive drugs by weight category compared to recommendations in the literature.
| | Drugs | Weight category | Patients evaluated | Doses | Mean dose (mcg/kg/min) | Median Dose (mcg/kg/min) | Minimum (mcg/kg/min) | Maximum (mcg/kg/min) | Literature dose recommendation [11–16] |
| | Dobutamine | Underweight | 1 | 1 | 2.50 | 2.50 | 2.50 | 2.50 | Inotropic support
2.5–15 mcg/kg/min
Maximum: 40 mcg/kg/min | | Normal weight | 4 | 7 | 4.11 | 2.76 | 2.29 | 10.05 | | Overweight | 1 | 1 | 2.52 | 2.52 | 2.52 | 2.52 | | Obese | 1 | 2 | 7.50 | 7.50 | 5.00 | 5.00 | | Extremely obese | 3 | 6 | 3.26 | 3.00 | 2.50 | 5.00 |
| | Dopamine | Underweight | 1 | 4 | 6.75 | 7.50 | 4.00 | 8.01 | Shock/hypotension
2–50 mcg/kg/min
Titrate to desired effect (i.e., mean arterial pressure >65 mmHg) | | Normal weight | 3 | 20 | 7.78 | 7.01 | 1.04 | 15.69 | | Overweight | 9 | 21 | 4.80 | 5.00 | 1.00 | 10.00 | | Obese | 4 | 12 | 7.45 | 5.00 | 2.49 | 20.00 | | Extremely obese | 3 | 17 | 5.09 | 5.00 | 1.00 | 13.87 |
| | | Underweight | 0 | 0 | — | — | — | — | Inotropic support
Initial: 50 mcg/kg
Maintenance: 0.375–0.75 mcg/kg/min
Maximum: 1.13 mg/kg/day
CrCl < 50: 0.43
CrCl < 40: 0.38 | | | Normal weight | 3 | 11 | 0.36 | 0.37 | 0.19 | 0.50 | | Milrinone | Overweight | 2 | 3 | 0.43 | 0.50 | 0.30 | 0.50 | | | Obese | 1 | 4 | 0.27 | 0.25 | 0.20 | 0.38 | | | Extremely obese | 2 | 3 | 0.77 | 0.78 | 0.51 | 1.04 |
| | Nitroglycerin | Underweight | 0 | 0 | — | — | — | — | Acute myocardial infarction
Initial: 0.20 mcg/kg/min
Usual range: 0.20–1.50 mcg/kg/min | | Normal weight | 2 | 4 | 0.28 | 0.24 | 0.17 | 0.47 | | Overweight | 8 | 15 | 0.34 | 0.26 | 0.06 | 0.85 | | Obese | 4 | 4 | 0.26 | 0.24 | 0.07 | 0.47 | | Extremely obese | 1 | 1 | 0.36 | 0.36 | 0.36 | 0.36 |
| | Norepinephrine | Underweight | 1 | 5 | 0.19 | 0.22 | 0.06 | 0.33 | Shock
Initial: 0.01–3.00 mcg/kg/min
Titrate to desired response (i.e., mean arterial pressure >65 mmHg)
Usual Range: 8–30 mcg/min | | Normal weight | 3 | 12 | 0.10 | 0.10 | 0.07 | 0.14 | | Overweight | 4 | 4 | 0.14 | 0.15 | 0.06 | 0.14 | | Obese | 5 | 30 | 0.06 | 0.04 | 0.01 | 0.30 | | Extremely obese | 2 | 10 | 0.05 | 0.04 | 0.02 | 0.07 |
| | Phenylephrine | Underweight | 0 | 0 | — | — | — | — | Shock
Initial: 100–500 mcg IV bolus
IV infusion: 0.50 mcg/kg/min
Titrate to desired effect
Reported ranges: 0.40–9.10 mcg/kg/min | | Normal weight | 2 | 23 | 0.66 | 0.69 | 0.14 | 1.10 | | Overweight | 4 | 6 | 0.84 | 0.59 | 0.45 | 2.00 | | Obese | 0 | 0 | NA | NA | NA | NA | | Extremely obese | 2 | 2 | 0.83 | 0.83 | 0.10 | 1.56 |
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