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Late Vasopressor Administration in Patients in the ICU: A Retrospective Cohort Study.

Abstract：

BACKGROUND:Little is known about the prevalence, predictors, and outcomes of late vasopressor administration which evolves after admission to the ICU. RESEARCH QUESTION:What is the epidemiology of late vasopressor administration in the ICU? STUDY DESIGN AND METHODS:We retrospectively studied a cohort of veterans admitted to the Veterans Administration ICUs for ≥ 4 days from 2014 to 2017. The timing of vasopressor administration was categorized as early (only within the initial 3 days), late (on day 4 or later and none on day 3), and continuous (within the initial 2 days through at least day 4). Regressions were performed to identify patient factors associated with late vasopressor administration and the timing of vasopressor administration with posthospitalization discharge mortality. RESULTS:Among the 62,206 hospitalizations with at least 4 ICU days, late vasopressor administration occurred in 5.5% (3,429 of 62,206). Patients with more comorbidities (adjusted OR [aOR], 1.02 per van Walraven point; 95% CI, 1.02-1.03) and worse severity of illness on admission (aOR, 1.01 per percentage point risk of death; 95% CI, 1.01-1.02) were more likely to receive late vasopressor therapy. Nearly 50% of patients started a new antibiotic within 24 h of receiving late vasopressor therapy. One-year mortality after survival to discharge was higher for patients with continuous (adjusted hazard ratio [aHR], 1.48; 95% CI, 1.33-1.65) and late vasopressor administration (aHR, 1.26; 95% CI, 1.15-1.38) compared with only early vasopressor administration. INTERPRETATION:Late vasopressor administration was modestly associated with comorbidities and admission illness severity. One-year mortality was higher among those who received late vasopressor administration compared with only early vasopressor administration. Research to understand optimization of late vasopressor therapy administration may improve long-term mortality.

journal_name

Chest

journal_title

Chest

authors

Viglianti EM,Bagshaw SM,Bellomo R,McPeake J,Molling DJ,Wang XQ,Seelye S,Iwashyna TJ

doi

10.1016/j.chest.2020.02.071

subject

Has Abstract

pub_date

2020-08-01 00:00:00

pages

571-578

issue

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(20)30591-2

journal_volume

158

pub_type

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Late Vasopressor Administration in Patients in the ICU: A Retrospective Cohort Study.