Intensive care patients receiving vasoactive medications: A retrospective cohort study

Abstract

Background: Vasoactive medications are high-risk drugs commonly used in intensive care units (ICUs), which have wide variations in clinical management. Objectives: The aim of this study was to describe the patient population, treatment, and clinical characteristics of patients who did and did not receive vasoactive medications while in the ICU and to develop a predictive tool to identify patients needing vasoactive medications. Methods: A retrospective cohort study of patients admitted to a level three tertiary referral ICU over a 12month period from October 2018 to September 2019 was undertaken. Data from electronic medical records were analysed to describe patient characteristics in an adult ICU. Chi square and ManneWhitney U tests were used to analyse data relating to patients who did and did not receive vasoactive medications. Univariate analysis and Pearson's r 2 were used to determine inclusion in multivariable logistic regression. Results: Of 1276 patients in the cohort, 40% (512/1276) received a vasoactive medication for haemodynamic support, with 84% (428/512) receiving noradrenaline. Older patients (odds ratio [OR] ¼ 1.02; 95% confidence interval [CI] ¼ 1.01e1.02; p < 0.001) with higher Acute Physiology and Chronic Health Evaluation (APACHE) III scores (OR ¼ 1.04; 95% CI ¼ 1.03e1.04; p < 0.001) were more likely to receive vasoactive medications than those not treated with vasoactive medications during an intensive care admission. A model developed using multivariable analysis predicted that patients admitted with sepsis (OR ¼ 2.43; 95% CI ¼ 1.43e4.12; p ¼ 0.001) or shock (OR ¼ 4.05; 95% CI ¼ 2.68e6.10; p < 0.001) and managed on mechanical ventilation (OR ¼ 3.76; 95% CI ¼ 2.81e5.02; p < 0.001) were more likely to receive vasoactive medications. Conclusions: Mechanically ventilated patients admitted to intensive care for sepsis and shock with higher APACHE III scores were more likely to receive vasoactive medications. Predictors identified in the multivariable model can be used to direct resources to patients most at risk of receiving vasoactive medications.

Vasoactive Inotropic Score compared to the sequential organ failure assessment cardiovascular score in intensive care

“…Hence, it would make sense to score 0 cardiovascular SOFA points to patients who do not receive any vasopressor/inotropic agents and to use the scale of 1–4 points to categorise the magnitude of vasopressor/inotropic medication needed. In our study, one third of patients received any vasopressor/inotropic support which is in line with previous studies done in ICU patients without preceding cardiac surgery 29,30 …”

“…In our study, one third of patients received any vasopressor/inotropic support which is in line with previous studies done in ICU patients without preceding cardiac surgery. 29,30 Previously…”

The influence of intensive care unit culture and environment on nurse decision‐making when managing vasoactive medications: A qualitative exploratory study

“…Exploring intensive care unit (ICU) nurse decision‐making when managing vasoactive medications requires knowledge of vasoactive medications, an understanding intensive care nursing practices, unit culture, social interactions and the ICU environment. Between 10 and 56% of patients in ICU receive one or more vasoactive medications, and the most common agent is noradrenaline (norepinephrine) (Hunter et al, 2021; Jentzer et al, 2020). Noradrenaline (norepinephrine) is the vasoactive medication of interest for this study due to the nurse decision‐making actions required to titrate and wean the infusions (Hunter et al, 2020), and for the remainder of this article, noradrenaline (norepinephrine) will be referred to as noradrenaline (Changes to adrenaline and noradrenaline labels, 2020).…”