Variation in Fluid and Vasopressor Use in Shock With and Without Physiologic Assessment: A Multicenter Observational Study
Year: 2020
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: 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. DESIGN: Multicenter prospective cohort study between September 2017 and February 2018. SETTINGS: Thirty-four hospitals in the United States and Jordan. PATIENTS: 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. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: 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). CONCLUSIONS: The use of physiologic assessment in the 24 hours after shock onset is associated with increased use of vasopressor but not with fluid administration.
Source: Critical Care Medicine
Authors: Jen-Ting Chen, Russel Roberts, Melissa J. Fazzari, Kianoush Kashani, Nida Qadir, Charles B. Cairns, Kusum Mathews, Pauline Park, Akram Khan, James F. Gilmore, Anne Rain T. Brown, Betty Tsuei, Michele Handzel, Alfredo Lee Chang, Abhijit Duggal, Michael Lanspa, James Taylor Herbert, Anthony Martinez, Joseph Tonna, Mahmoud A. Ammar, Drayton Hammond, Lama H. Nazer, Mojdeh Heavner, Erin Pender, Lauren Chambers, Michael T. Kenes, David Kaufman, April Downey, Brent Brown, Darlene Chaykosky, Armand Wolff, Michael Smith, Katie Nault, Jonathan Sevransky, Michelle N. Gong, on behalf of the VOLUME-CHASERS Study Group and Society of Critical Care Medicine Discovery Network
Institutions: Albert Einstein College of Medicine, Montefiore Medical Center, Massachusetts General Hospital, Mayo Clinic, University of California, Los Angeles, University of Arizona, Mount Sinai Health System, University of Michigan, Oregon Health & Science University, Brigham and Women's Hospital, The University of Texas MD Anderson Cancer Center, University of Cincinnati, University of Rochester Medicine, University of Southern California, Cleveland Clinic, Intermountain Healthcare, Duke University, Duke Medical Center, Saint Agnes Hospital, University of Utah, Yale New Haven Health System, Rush University Medical Center, King Hussein Cancer Center, University of Maryland Medical Center, Truman Medical Center, University of Missouri–Kansas City, Vidant Medical Center, Atrium Health Wake Forest Baptist, New York University, Riverside Methodist Hospital, University of Oklahoma Health Sciences Center, Geisinger Wyoming Valley Medical Center, Bridgeport Hospital, Lakes Region General Hospital, Lahey Hospital and Medical Center, Lahey Medical Center, Emory University Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: United Therapeutics Corporation, Johns Hopkins University, LivaNova, National Institutes of Health, U.S. Food and Drug Administration, Agency for Healthcare Research and Quality, Biomedical Advanced Research and Development Authority, National Heart, Lung, and Blood Institute, National Center for Advancing Translational Sciences
OpenAlex ID: W3038852105