TY - JOUR
T1 - Temporal Trends and Clinical Outcomes Associated with Vasopressor and Inotrope Use in the Cardiac Intensive Care Unit
AU - Jentzer, Jacob C.
AU - Wiley, Brandon
AU - Bennett, Courtney
AU - Murphree, Dennis H.
AU - Keegan, Mark T.
AU - Kashani, Kianoush B.
AU - Bell, Malcolm R.
AU - Barsness, Gregory W.
N1 - Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Background:The use of norepinephrine may be associated with better outcomes in some patients with shock. We sought to determine whether norepinephrine was associated with lower mortality in unselected cardiac intensive care unit (CICU) patients compared with other vasopressors, and whether patterns of vasopressor and inotrope usage in the CICU have changed over time.Methods:We retrospectively evaluated consecutive adult patients admitted to a tertiary care hospital CICU from January 1, 2007 to December 31, 2015. Vasoactive drug doses were quantified using the peak Vasoactive-Inotropic Score (VIS). Temporal trends were assessed using the Cochran-Armitage trends test and multivariable logistic regression was used to determine predictors of hospital mortality.Results:We included 10,004 patients with a mean age of 67±15 years; vasoactive drugs were used in 2,468 (24.7%) patients. Use of norepinephrine increased over time, whereas dopamine utilization decreased (P<0.001 for trends). After adjustment for illness severity and other variables, the peak VIS was a predictor of hospital mortality across the entire population (unit odds ratio [OR] 1.013, 95% confidence interval [CI], 1.009-1.017, P<0.001) and among patients receiving vasoactive drugs (OR 1.018, 95% CI, 1.013-1.022, P<0.001). Among patients receiving vasoactive drugs, norepinephrine was associated with a lower risk of hospital mortality (OR 0.66, 95% CI, 0.49-0.90, P=0.008) after adjustment for illness severity and peak VIS.Conclusions:Vasoactive drug use in CICU patients has a dose-dependent association with short-term mortality. Use of norepinephrine in CICU patients is associated with decreased odds of death when compared with other vasoactive drugs.
AB - Background:The use of norepinephrine may be associated with better outcomes in some patients with shock. We sought to determine whether norepinephrine was associated with lower mortality in unselected cardiac intensive care unit (CICU) patients compared with other vasopressors, and whether patterns of vasopressor and inotrope usage in the CICU have changed over time.Methods:We retrospectively evaluated consecutive adult patients admitted to a tertiary care hospital CICU from January 1, 2007 to December 31, 2015. Vasoactive drug doses were quantified using the peak Vasoactive-Inotropic Score (VIS). Temporal trends were assessed using the Cochran-Armitage trends test and multivariable logistic regression was used to determine predictors of hospital mortality.Results:We included 10,004 patients with a mean age of 67±15 years; vasoactive drugs were used in 2,468 (24.7%) patients. Use of norepinephrine increased over time, whereas dopamine utilization decreased (P<0.001 for trends). After adjustment for illness severity and other variables, the peak VIS was a predictor of hospital mortality across the entire population (unit odds ratio [OR] 1.013, 95% confidence interval [CI], 1.009-1.017, P<0.001) and among patients receiving vasoactive drugs (OR 1.018, 95% CI, 1.013-1.022, P<0.001). Among patients receiving vasoactive drugs, norepinephrine was associated with a lower risk of hospital mortality (OR 0.66, 95% CI, 0.49-0.90, P=0.008) after adjustment for illness severity and peak VIS.Conclusions:Vasoactive drug use in CICU patients has a dose-dependent association with short-term mortality. Use of norepinephrine in CICU patients is associated with decreased odds of death when compared with other vasoactive drugs.
KW - Cardiac intensive care unit
KW - cardiogenic shock
KW - coronary care unit
KW - inotropes
KW - mortality
KW - norepinephrine
KW - shock
KW - vasopressors
UR - http://www.scopus.com/inward/record.url?scp=85081942724&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85081942724&partnerID=8YFLogxK
U2 - 10.1097/SHK.0000000000001390
DO - 10.1097/SHK.0000000000001390
M3 - Article
C2 - 31169766
AN - SCOPUS:85081942724
SN - 1073-2322
VL - 53
SP - 452
EP - 459
JO - Shock
JF - Shock
IS - 4
ER -