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)
Text
210582.pdf - Accepted Version Available under License Creative Commons Attribution Non-commercial No Derivatives. 499kB |
Abstract
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]. |
Status: | Published |
Refereed: | Yes |
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 |
Publisher: | Elsevier |
ISSN: | 0012-3692 |
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 |
University Staff: Request a correction | Enlighten Editors: Update this record