Temporal Trends and Clinical Outcomes Associated with Vasopressor and Inotrope Use in the Cardiac Intensive Care Unit

Jacob C. Jentzer, Brandon Wiley, Courtney Bennett, Dennis H. Murphree, Mark T. Keegan, Kianoush B. Kashani, Malcolm R. Bell, Gregory W. Barsness

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)452-459
Number of pages8
JournalShock
Volume53
Issue number4
DOIs
StatePublished - Apr 1 2020

Keywords

  • Cardiac intensive care unit
  • cardiogenic shock
  • coronary care unit
  • inotropes
  • mortality
  • norepinephrine
  • shock
  • vasopressors

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Temporal Trends and Clinical Outcomes Associated with Vasopressor and Inotrope Use in the Cardiac Intensive Care Unit'. Together they form a unique fingerprint.

Cite this