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

Authors

Jen-Ting Chen, Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
Russel Roberts, Department of Pharmacy, Massachusetts General Hospital, Boston, MA.
Melissa J. Fazzari, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY.
Kianoush Kashani, Mayo Clinic, Rochester, MN.Follow
Nida Qadir, University of California Los Angeles, Los Angeles, CA.Follow
Charles B. Cairns, University of Arizona, Tucson, AZ.Follow
Kusum Mathews, Mount Sinai Health System, New York, NY.
Pauline Park, University of Michigan, Ann Arbor, MI.Follow
Akram Khan, Oregon Health and Science University, Portland, OR.Follow
James F. Gilmore, Brigham and Women's Hospital, Boston, MA.

Document Type

Article

Publication Title

Critical care medicine

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.

First Page

1436

Last Page

1444

DOI

10.1097/CCM.0000000000004429

Publication Date

10-1-2020

Recommended Citation

Chen, Jen-Ting; Roberts, Russel; Fazzari, Melissa J.; Kashani, Kianoush; Qadir, Nida; Cairns, Charles B.; Mathews, Kusum; Park, Pauline; Khan, Akram; and Gilmore, James F., "Variation in Fluid and Vasopressor Use in Shock With and Without Physiologic Assessment: A Multicenter Observational Study" (2020). Critical Care. 15.
https://scholar.bridgeporthospital.org/critical_care/15

Identifier

32618697 (pubmed); NIHMS1849919 (mid); PMC10072792 (pmc); 10.1097/CCM.0000000000004429 (doi); 00003246-202010000-00005 (pii)