Does high-dose vasopressor therapy in medical intensive care patients indicate what we already suspect?

作者：Sviri S; Hashoul J; Stav I; van Heerden P V^*

来源：Journal of Critical Care, 2014, 29(1): 157-160.

DOI：10.1016/j.jcrc.2013.09.004

• ICU outcome
• Vasopressors
• Mortality

Purpose: This study was conducted to determine the association between vasopressor requirement and outcome in medical intensive care patients in an environment where treatment is not withdrawn.
Materials and Methods: This was an observational study of patients in the medical intensive care unit (ICU) over a period of 18 months to determine the correlation between vasopressor requirement and mortality. Outcome was determined for all medical ICU patients, for patients receiving "low dose" (<40 mu g/min) vasopressors (noradrenaline and/or adrenaline) or "high dose" (>= 40 mu g/min) vasopressors. Receiver operator characteristic curves were constructed for ICU and hospital mortality and high-dose vasopressor use. High-dose vasopressor use as an independent predictor for ICU and hospital mortality was also determined by multiple logistic regression analysis.
Results: Patients receiving high-dose noradrenaline at any time during their ICU admission had an 84.3% mortality in ICU and 90% in hospital. The receiver operator characteristic curves for high-dose vasopressors had an area under the curve of 0.799 for ICU mortality and 0.779 for hospital mortality. High-dose vasopressor was an independent predictor of ICU mortality, with an odds ratio of 5.1 (confidence interval, 2.02-12.9; P=.001), and of hospital mortality, with an odds ratio of 3.82 (confidence interval 1.28-11.37; P=.016).
Conclusions: The requirement for high-dose vasopressor therapy at any time during ICU admission was associated with a very high mortality rate in the ICU and the hospital.

• 出版日期2014-2