Abstract
BackgroundThe choice of vasopressor use in the intensive care unit (ICU) depends primarily on provider preference. This study aims to describe the rate of vasopressor utilization and the trends of each vasoactive agent usage in the ICU over the span of 7 years in a tertiary referral center.MethodsAll adult ICU admissions, including medical, cardiac, and surgical ICUs from January 1st, 2007 through December 31st, 2013 were included in this study. Vasopressor use was defined as the continuous intravenous administration of epinephrine, norepinephrine, phenylephrine, dopamine, or vasopressin within a given ICU day. The vasopressor utilization index (VUI) was defined as the proportion of ICU days on each vasoactive agent divided by the total ICU days with vasopressor usage.ResultsDuring the study period, 72,005 ICU admissions and 272,271 ICU days were screened. Vasopressors were used in 19,575 ICU admissions (27 %) and 59,811 ICU days (22 %). Vasopressin was used in 24,496 (41 %), epinephrine in 23,229 (39 %), norepinephrine in 20,648 (34 %), dopamine in 9449 (16 %), and phenylephrine in 7508 (13 %) ICU days. The VUInorepinephrine increased from 0.24 in 2007 to 0.46 in 2013 and VUIphenylephrine decreased from 0.20 in 2007 to 0.08 in 2013 (p < 0.001 both). For epinephrine, dopamine, and vasopressin VUI did not change over the course of study.ConclusionVasopressors were used in about one fourth of ICU admissions and about one-fifth of ICU days. Although vasopressin is the most commonly used vasopressor, the use of norepinephrine found to have an increasing trajectory.Electronic supplementary materialThe online version of this article (doi:10.1186/s40360-016-0063-z) contains supplementary material, which is available to authorized users.
Highlights
The choice of vasopressor use in the intensive care unit (ICU) depends primarily on provider preference
Circulatory shock is defined as mismatch among oxygen delivery and tissue consumption which leads to endorgan damage, multisystem organ failure, and potentially death [1, 2]
Vasopressors were most commonly employed in the cardiac surgery ICU (55 % of ICU admissions and 47 % of total ICU days)
Summary
The choice of vasopressor use in the intensive care unit (ICU) depends primarily on provider preference. The Surviving Sepsis Campaign guidelines for septic shock recommend a mean arterial pressure (MAP) of ≥65 mmHg to achieve adequate end-organ perfusion [11]. Vasoactive agents such as epinephrine, norepinephrine, phenylephrine, dopamine, and vasopressin have increasingly become an integrated therapeutic cornerstone for the management of septic shock. Following the publication of the early goal-directed therapy (EGDT) paper in 2001 [12], there have been a large number of clinical trials with a focus on the efficacy and adverse effects of vasoactive agents for the management of shock [13,14,15,16,17,18,19,20,21,22,23]. Guidelines for the management of circulatory shock have emphasized the use of some of the vasopressors in certain conditions based on their physiology, animal data, and expert opinions
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
