Late vasopressor administration in ICU patients: a retrospective cohort study

Viglianti, E. M., Bagshaw, S. M., Bellomo, R., McPeake, J. , Molling, D. J., Qing, X., Steelye, S. and Iwashyna, T. J. (2020) Late vasopressor administration in ICU patients: a retrospective cohort study. Chest, 158(2), pp. 571-578. (doi: 10.1016/j.chest.2020.02.071) (PMID:32278780)

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Background: Little is known about the prevalence, predictors, and outcomes of late vasopressor administration which evolves after admission to 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.

Item Type:Articles
Additional Information:This work was supported by the National Institutes of Health [Grants T32 HL7749-25 , K12 HL138039-02 to Dr Viglianti], the Department of Veterans Affairs Health Services Research & Development service [Grants IIR 13-079, 17-219 to Dr Iwashyna], and a Canada Research Chair in Critical Care Nephrology [to Dr Bagshaw].
Glasgow Author(s) Enlighten ID:McPeake, Dr Jo
Authors: Viglianti, E. M., Bagshaw, S. M., Bellomo, R., McPeake, J., Molling, D. J., Qing, X., Steelye, S., and Iwashyna, T. J.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
Journal Name:Chest
ISSN (Online):1931-3543
Published Online:09 April 2020
Copyright Holders:Copyright © 2020 American College of Chest Physicians
First Published:First published in Chest 158(2): 571-578
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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