Predictors of Vasopressin Responsiveness in Critically Ill Adults
| Autor: | Steven Wolf, Mark Shapiro, Daniel L Gilstrap, Bridgette Kram, Brittainy Allen, Jennifer Schultheis, Shawn Kram |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Vasopressin Vasopressins Critical Illness law.invention 03 medical and health sciences 0302 clinical medicine law medicine Humans Vasoconstrictor Agents Arterial Pressure Pharmacology (medical) 030212 general & internal medicine Intensive care medicine Aged Retrospective Studies Critically ill business.industry 030208 emergency & critical care medicine Middle Aged Shock Septic Intensive care unit Intensive Care Units Shock (circulatory) Critical illness Female medicine.symptom business hormones hormone substitutes and hormone antagonists |
| Zdroj: | Annals of Pharmacotherapy. 52:126-132 |
| ISSN: | 1542-6270 1060-0280 |
| DOI: | 10.1177/1060028017729480 |
| Popis: | Vasopressin is commonly used as an adjunct vasopressor in shock. However, response to vasopressin varies among critically ill patients.To identify patient-specific factors that are associated with vasopressin responsiveness in critically ill adults.This retrospective, multicenter study included adult patients who were admitted to an intensive care unit (ICU) and received vasopressin for shock. Patients were excluded if they received vasopressin for less than 30 minutes, if vasopressin was initiated prior to ICU arrival, or if an additional vasopressor was initiated within 30 minutes of starting vasopressin. Responsiveness was defined as an increase in mean arterial pressure of ≥10 mm Hg or the ability to taper a concurrent catecholamine vasopressor. Patient-specific factors evaluated in a multivariate analysis included age, gender, ethnicity, body mass index, type of shock, serum pH, Sequential Organ Failure Assessment (SOFA) score, and use of stress-dose steroids. These variables were also evaluated in a subgroup analysis of patients with septic shock.Of 1619 patients screened, 400 patients were included, with 231 identified as vasopressin responsive and 169 as nonresponsive. Vasopressin used as an adjunct vasopressor, as opposed to first line, during shock was the only variable associated with vasopressin responsiveness (odds ratio [OR] = 1.71; 95% CI = 1.10 to 2.65). Among the subgroup of patients with septic shock, female patients had a higher odds of responding than male patients (OR = 2.10; 95% CI = 1.12 to 3.95).Vasopressin initiated as an adjunct vasopressor, as opposed to first-line therapy, was associated with response. |
| Databáze: | OpenAIRE |
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