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• W4313267132 abstract "Introduction: Shock requiring high-dose vasopressor therapy (HDVT) is associated with high mortality. In those receiving HDVT it is unclear if addition of adjunct therapies leads to improved patient outcomes. Angiotensin II (AG2) is a non-catecholamine vasoconstrictor FDA approved for adults with septic or other distributive shock. Our study looked to describe the response and survival of those on HDVT who received AG2 within our healthcare system. Methods: This is a multicenter, retrospective cohort study of all adult patients on HDVT who received AG2 admitted within 12 acute care facilities between October 1, 2018 and June 9, 2022. The primary outcomes were inpatient survival, response to AG2 (reduction in vasopressor requirements or MAP ≥65mmHg if not achieved prior to AG2 initiation), and impact of AG2 response on survival. Secondary analyses included the impact of cardiac index (CI) and norepinephrine equivalents (NEE) on survival and response. Results: Forty-nine patients had AG2 ordered during the study period of which 38 patients received AG2. Patients could be classified as medical 30 (78.9%), surgical/trauma 6 (15.8%) or cardiac/cardiothoracic surgery 2 (5.3%). The median NEE at time of AG2 initiation was 1.2 (0.84-1.7) mcg/kg/min. Ten patients (26.3%) survived hospitalization, and 20 (52.6%) responded to the AG2. More responders survived 8 (40%) compared to 2 (11.1%) p=.04. Pre AG2 CI was documented in 26 patients, 17 (65.4%) had a CI >3. Seven (41.2%) with a CI >3 survived compared to 1 (11.1%) with a CI < 3 p=.11. Eleven (64.7%) with a CI >3 responded compared to 6 (66.7%) with a CI < 3 p=NS. Five (35.7%) with NEE < 1.05 mcg/kg/min survived compared to 5 (20.8%) with NEE ≥1.05 mcg/kg/min p=.31. Ten (71.4%) with NEE < 1.05 mcg/kg/min responded compared to 10 (42.7%) with NEE ≥1.05 mcg/kg/min p=NS. Nine patients had CI >3 and baseline NEE < 1.05 mcg/kg/min of which 4 (44.4%) survived and 7 (77.7%) responded. Conclusions: We observed high mortality in our population of primarily medical critical care patients on HDVT receiving AG2 with approximately half demonstrating anticipated hemodynamic response. Responders to AGII were more likely to survive. Further research is needed to determine if patients with a higher CI and on lower baseline NEE are more likely to survive and respond to AG2" @default.
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• W4313267132 date "2022-12-15" @default.
• W4313267132 modified "2023-09-25" @default.
• W4313267132 title "1260: RESPONSE TO ANGIOTENSIN II IN PATIENTS ON HIGH-DOSE VASOPRESSOR THERAPY IS ASSOCIATED WITH SURVIVAL" @default.
• W4313267132 doi "https://doi.org/10.1097/01.ccm.0000910776.89495.7b" @default.
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