TY - JOUR
T1 - Late Vasopressor Administration in Patients in the ICU
T2 - A Retrospective Cohort Study
AU - Viglianti, Elizabeth M.
AU - Bagshaw, Sean M.
AU - Bellomo, Rinaldo
AU - McPeake, Joanne
AU - Molling, Daniel J.
AU - Wang, Xiao Qing
AU - Seelye, Sarah
AU - Iwashyna, Theodore J.
PY - 2020/8
Y1 - 2020/8
N2 - 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.
AB - 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.
KW - cardiovascular failure
KW - outcomes
KW - persistent critical illness
KW - prolonged ICU stay
KW - sepsis
KW - vasopressors
UR - http://www.scopus.com/inward/record.url?scp=85086007322&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2020.02.071
DO - 10.1016/j.chest.2020.02.071
M3 - Article
C2 - 32278780
AN - SCOPUS:85086007322
SN - 0012-3692
VL - 158
SP - 571
EP - 578
JO - Chest
JF - Chest
IS - 2
ER -