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• W3015520002 abstract "Background Little is known about the prevalence, predictors, and outcomes of late vasopressor administration which evolves after admission to the ICU. Research Question What is the epidemiology of late vasopressor administration in the ICU? Study Design and Methods We retrospectively studied a cohort of veterans admitted to the Veterans Administration ICUs for ≥ 4 days from 2014 to 2017. The timing of vasopressor administration was categorized as early (only within the initial 3 days), late (on day 4 or later and none on day 3), and continuous (within the initial 2 days through at least day 4). Regressions were performed to identify patient factors associated with late vasopressor administration and the timing of vasopressor administration with posthospitalization discharge mortality. Results Among the 62,206 hospitalizations with at least 4 ICU days, late vasopressor administration occurred in 5.5% (3,429 of 62,206). Patients with more comorbidities (adjusted OR [aOR], 1.02 per van Walraven point; 95% CI, 1.02-1.03) and worse severity of illness on admission (aOR, 1.01 per percentage point risk of death; 95% CI, 1.01-1.02) were more likely to receive late vasopressor therapy. Nearly 50% of patients started a new antibiotic within 24 h of receiving late vasopressor therapy. One-year mortality after survival to discharge was higher for patients with continuous (adjusted hazard ratio [aHR], 1.48; 95% CI, 1.33-1.65) and late vasopressor administration (aHR, 1.26; 95% CI, 1.15-1.38) compared with only early vasopressor administration. Interpretation Late vasopressor administration was modestly associated with comorbidities and admission illness severity. One-year mortality was higher among those who received late vasopressor administration compared with only early vasopressor administration. Research to understand optimization of late vasopressor therapy administration may improve long-term mortality. Little is known about the prevalence, predictors, and outcomes of late vasopressor administration which evolves after admission to the ICU. What is the epidemiology of late vasopressor administration in the ICU? We retrospectively studied a cohort of veterans admitted to the Veterans Administration ICUs for ≥ 4 days from 2014 to 2017. The timing of vasopressor administration was categorized as early (only within the initial 3 days), late (on day 4 or later and none on day 3), and continuous (within the initial 2 days through at least day 4). Regressions were performed to identify patient factors associated with late vasopressor administration and the timing of vasopressor administration with posthospitalization discharge mortality. Among the 62,206 hospitalizations with at least 4 ICU days, late vasopressor administration occurred in 5.5% (3,429 of 62,206). Patients with more comorbidities (adjusted OR [aOR], 1.02 per van Walraven point; 95% CI, 1.02-1.03) and worse severity of illness on admission (aOR, 1.01 per percentage point risk of death; 95% CI, 1.01-1.02) were more likely to receive late vasopressor therapy. Nearly 50% of patients started a new antibiotic within 24 h of receiving late vasopressor therapy. One-year mortality after survival to discharge was higher for patients with continuous (adjusted hazard ratio [aHR], 1.48; 95% CI, 1.33-1.65) and late vasopressor administration (aHR, 1.26; 95% CI, 1.15-1.38) compared with only early vasopressor administration. Late vasopressor administration was modestly associated with comorbidities and admission illness severity. One-year mortality was higher among those who received late vasopressor administration compared with only early vasopressor administration. Research to understand optimization of late vasopressor therapy administration may improve long-term mortality. Better Late Than Never? Timing of Vasopressor Administration in the ICUCHESTVol. 158Issue 2PreviewOne of the most common interventions in critically ill patients is vasopressor drug infusion; however, this therapy has not attracted the same level of research interest as other organ supports in the ICU. This is likely because of perceptions as a comparatively low-level intervention compared with mechanical ventilation or renal replacement therapy, despite the high mortality associated with diagnoses requiring vasopressor therapy. This approaches 20% for critically ill patients with sepsis,1,2 a condition which in turn represents 20% of all global deaths. Full-Text PDF" @default.
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• W3015520002 date "2020-08-01" @default.
• W3015520002 modified "2023-10-09" @default.
• W3015520002 title "Late Vasopressor Administration in Patients in the ICU" @default.
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• W3015520002 doi "https://doi.org/10.1016/j.chest.2020.02.071" @default.
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