Outcomes of Patients on Multiple Vasoactive Drugs for Shock
| Autor: | C. O. Prys-Picard, Victor J. Cardenas, Gulshan Sharma, Brandie D. Williams, Shiwan K. Shah |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Adult
Male Cardiotonic Agents Adolescent Critical Care Endpoint Determination Critical Care and Intensive Care Medicine law.invention Norepinephrine (medication) Young Adult law Intensive care medicine Humans Vasoconstrictor Agents Simplified Acute Physiology Score Aged Retrospective Studies business.industry Retrospective cohort study Middle Aged Shock Septic Survival Analysis Texas Intensive care unit Cardiopulmonary Resuscitation Treatment Outcome Epinephrine Shock (circulatory) Anesthesia Drug Therapy Combination Female Dobutamine medicine.symptom business medicine.drug |
| Zdroj: | Journal of Intensive Care Medicine. 28:237-240 |
| ISSN: | 1525-1489 0885-0666 |
| DOI: | 10.1177/0885066612448738 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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