Outcomes of patients on multiple vasoactive drugs for shock

Curig O. Prys-Picard, Shiwan K. Shah, Brandie D. Williams, Victor Cardenas, Gulshan Sharma

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Introduction: Vasoactive drugs are routinely used in critically ill patients with shock to optimize the hemodynamic state while evaluating and treating potentially reversible causes. Limited data exist on the use of multiple vasoactive drugs in the intensive care unit. We hypothesize that the use of 3 or more vasoactive drugs is associated with worse outcomes. Methods: We retrospectively examined the outcome in patients, at least 18 years of age, in whom 3 or more vasoactive drugs were administered simultaneously. We included patients admitted between November 2007 and August 2009. Vasoactive drugs included dopamine, dobutamine, epinephrine, norepinephrine, phenylephrine, and vasopressin. The primary end point was survival to hospital discharge. Results: Sixty-six patients received 3 or more vasoactive drugs simultaneously. Nine patients (14%) survived to ICU discharge and 6 patients (9%) survived to hospital discharge. There was a significant difference in mean Simplified Acute Physiology Score II between survivors (32.3 + 28.6) and nonsurvivors (72.1 + 30.4), P = .003. Five of the 6 survivors had an acute cardiac procedure, either percutaneous cardiac intervention or heart transplantation. The 1 patient with septic shock who survived had surgery for a bowel perforation. All patients who survived received inotropic therapy (dobutamine). None of the patients who received 4 or more vasoactive drugs survived. Conclusion: Patients requiring 3 or more vasoactive drugs rarely survive in the absence of an intervention aimed at correcting the underlying cause such as revascularization or source control surgery

Original languageEnglish (US)
Pages (from-to)237-240
Number of pages4
JournalJournal of Intensive Care Medicine
Volume28
Issue number4
DOIs
StatePublished - Jul 1 2013

Keywords

  • inotropic agents
  • outcomes assessment
  • shock
  • vasoactive drugs
  • vasoconstrictor agents

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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