Predictors of response to fixed-dose vasopressin in adult patients with septic shock
Abstract Background Vasopressin is often utilized for hemodynamic support in patients with septic shock. However, the most appropriate patient to initiate therapy in is unknown. This study was conducted to determine factors associated with hemodynamic response to fixed-dose vasopressin in patients w...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2018-03-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13613-018-0379-5 |
| _version_ | 1818426225718198272 |
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| author | Gretchen L. Sacha Simon W. Lam Abhijit Duggal Heather Torbic Stephanie N. Bass Sarah C. Welch Robert S. Butler Seth R. Bauer |
| author_facet | Gretchen L. Sacha Simon W. Lam Abhijit Duggal Heather Torbic Stephanie N. Bass Sarah C. Welch Robert S. Butler Seth R. Bauer |
| author_sort | Gretchen L. Sacha |
| collection | DOAJ |
| description | Abstract Background Vasopressin is often utilized for hemodynamic support in patients with septic shock. However, the most appropriate patient to initiate therapy in is unknown. This study was conducted to determine factors associated with hemodynamic response to fixed-dose vasopressin in patients with septic shock. Methods Single-center, retrospective cohort of patients receiving fixed-dose vasopressin for septic shock for at least 6 h with concomitant catecholamines in the medical, surgical, or neurosciences intensive care unit (ICU) at a tertiary care center. Patients were classified as responders or non-responders to fixed-dose vasopressin. Response was defined as a decrease in catecholamine dose requirements and achievement of mean arterial pressure ≥ 65 mmHg at 6 h after initiation of vasopressin. Results A total of 938 patients were included: 426 responders (45%), 512 non-responders (55%). Responders had lower rates of in-hospital (57 vs. 72%; P < 0.001) and ICU mortality (50 vs. 68%; P < 0.001), and increased ICU-free days at day 14 and hospital-free days at day 28 (2.3 ± 3.8 vs. 1.6 ± 3.3; P < 0.001 and 4.2 ± 7.2 vs. 2.8 ± 6.0; P < 0.001, respectively). On multivariable analysis, non-medical ICU location was associated with increased response odds (OR 1.70; P = 0.0049) and lactate at vasopressin initiation was associated with decreased response odds (OR 0.93; P = 0.0003). Factors not associated with response included APACHE III score, SOFA score, corticosteroid use, and catecholamine dose. Conclusion In this evaluation, 45% responded to the addition of vasopressin with improved outcomes compared to non-responders. The only factors found to be associated with vasopressin response were ICU location and lactate concentration. |
| first_indexed | 2024-12-14T14:26:27Z |
| format | Article |
| id | doaj.art-462ce396a01d47bea6cd10b06d628b77 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-14T14:26:27Z |
| publishDate | 2018-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-462ce396a01d47bea6cd10b06d628b772022-12-21T22:57:55ZengSpringerOpenAnnals of Intensive Care2110-58202018-03-018111010.1186/s13613-018-0379-5Predictors of response to fixed-dose vasopressin in adult patients with septic shockGretchen L. Sacha0Simon W. Lam1Abhijit Duggal2Heather Torbic3Stephanie N. Bass4Sarah C. Welch5Robert S. Butler6Seth R. Bauer7Department of Pharmacy, Cleveland ClinicDepartment of Pharmacy, Cleveland ClinicRespiratory Institute, Cleveland ClinicDepartment of Pharmacy, Cleveland ClinicDepartment of Pharmacy, Cleveland ClinicDepartment of Pharmacy, Cleveland ClinicDepartment of Quantitative Health Sciences, Cleveland ClinicDepartment of Pharmacy, Cleveland ClinicAbstract Background Vasopressin is often utilized for hemodynamic support in patients with septic shock. However, the most appropriate patient to initiate therapy in is unknown. This study was conducted to determine factors associated with hemodynamic response to fixed-dose vasopressin in patients with septic shock. Methods Single-center, retrospective cohort of patients receiving fixed-dose vasopressin for septic shock for at least 6 h with concomitant catecholamines in the medical, surgical, or neurosciences intensive care unit (ICU) at a tertiary care center. Patients were classified as responders or non-responders to fixed-dose vasopressin. Response was defined as a decrease in catecholamine dose requirements and achievement of mean arterial pressure ≥ 65 mmHg at 6 h after initiation of vasopressin. Results A total of 938 patients were included: 426 responders (45%), 512 non-responders (55%). Responders had lower rates of in-hospital (57 vs. 72%; P < 0.001) and ICU mortality (50 vs. 68%; P < 0.001), and increased ICU-free days at day 14 and hospital-free days at day 28 (2.3 ± 3.8 vs. 1.6 ± 3.3; P < 0.001 and 4.2 ± 7.2 vs. 2.8 ± 6.0; P < 0.001, respectively). On multivariable analysis, non-medical ICU location was associated with increased response odds (OR 1.70; P = 0.0049) and lactate at vasopressin initiation was associated with decreased response odds (OR 0.93; P = 0.0003). Factors not associated with response included APACHE III score, SOFA score, corticosteroid use, and catecholamine dose. Conclusion In this evaluation, 45% responded to the addition of vasopressin with improved outcomes compared to non-responders. The only factors found to be associated with vasopressin response were ICU location and lactate concentration.http://link.springer.com/article/10.1186/s13613-018-0379-5SepsisSeptic shockVasopressorsVasopressinNorepinephrineCatecholamines |
| spellingShingle | Gretchen L. Sacha Simon W. Lam Abhijit Duggal Heather Torbic Stephanie N. Bass Sarah C. Welch Robert S. Butler Seth R. Bauer Predictors of response to fixed-dose vasopressin in adult patients with septic shock Annals of Intensive Care Sepsis Septic shock Vasopressors Vasopressin Norepinephrine Catecholamines |
| title | Predictors of response to fixed-dose vasopressin in adult patients with septic shock |
| title_full | Predictors of response to fixed-dose vasopressin in adult patients with septic shock |
| title_fullStr | Predictors of response to fixed-dose vasopressin in adult patients with septic shock |
| title_full_unstemmed | Predictors of response to fixed-dose vasopressin in adult patients with septic shock |
| title_short | Predictors of response to fixed-dose vasopressin in adult patients with septic shock |
| title_sort | predictors of response to fixed dose vasopressin in adult patients with septic shock |
| topic | Sepsis Septic shock Vasopressors Vasopressin Norepinephrine Catecholamines |
| url | http://link.springer.com/article/10.1186/s13613-018-0379-5 |
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