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Variation in Fluid and Vasopressor Use in Shock With and Without Physiologic Assessment: A Multicenter Observational Study
Journal article   Open access   Peer reviewed

Variation in Fluid and Vasopressor Use in Shock With and Without Physiologic Assessment: A Multicenter Observational Study

Jen-Ting Chen, Russel Roberts, Melissa J Fazzari, Kianoush Kashani, Nida Qadir, Charles B Cairns, Kusum Mathews, Pauline Park, Akram Khan, James F Gilmore, …
Critical care medicine, v 48(10), pp 1436-1444
Oct 2020
DOI: https://doi.org/10.1097/CCM.0000000000004429
PMID: 32618697
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10072792View
Accepted (AM)Open Access (License Unspecified),  Open

Abstract

Adult Aged Aged, 80 and over APACHE Blood Pressure Central Venous Pressure Dose-Response Relationship, Drug Female Fluid Therapy - methods Fluid Therapy - statistics & numerical data Hospital Mortality - trends Humans Intensive Care Units - statistics & numerical data Male Middle Aged Organ Dysfunction Scores Prospective Studies Shock - diagnosis Shock - drug therapy Shock - mortality Shock - therapy Vasoconstrictor Agents - administration & dosage Vasoconstrictor Agents - therapeutic use
To characterize the association between the use of physiologic assessment (central venous pressure, pulmonary artery occlusion pressure, stroke volume variation, pulse pressure variation, passive leg raise test, and critical care ultrasound) with fluid and vasopressor administration 24 hours after shock onset and with in-hospital mortality. Multicenter prospective cohort study between September 2017 and February 2018. Thirty-four hospitals in the United States and Jordan. Consecutive adult patients requiring admission to the ICU with systolic blood pressure less than or equal to 90 mm Hg, mean arterial blood pressure less than or equal to 65 mm Hg, or need for vasopressor. None. Of 1,639 patients enrolled, 39% had physiologic assessments. Use of physiologic assessment was not associated with cumulative fluid administered within 24 hours of shock onset, after accounting for baseline characteristics, etiology and location of shock, ICU types, Acute Physiology and Chronic Health Evaluation III, and hospital (beta coefficient, 0.04; 95% CI, -0.07 to 0.15). In multivariate analysis, the use of physiologic assessment was associated with a higher likelihood of vasopressor use (adjusted odds ratio, 1.98; 95% CI, 1.45-2.71) and higher 24-hour cumulative vasopressor dosing as norepinephrine equivalent (beta coefficient, 0.37; 95% CI, 0.19-0.55). The use of vasopressor was associated with increased odds of in-hospital mortality (adjusted odds ratio, 1.88; 95% CI, 1.27-2.78). In-hospital mortality was not associated with the use of physiologic assessment (adjusted odds ratio, 0.86; 95% CI, 0.63-1.18). The use of physiologic assessment in the 24 hours after shock onset is associated with increased use of vasopressor but not with fluid administration.

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9 citations in Scopus

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Web of Science research areas
Critical Care Medicine
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