Vasopressor Use for Severe Hypotension-A Multicentre Prospective Observational Study

• Published in: PloS one 2017-01, Vol.12 (1), p.e0167840-e0167840
• Main Authors: Lamontagne, Francois, Cook, Deborah J, Meade, Maureen O, Seely, Andrew, Day, Andrew G, Charbonney, Emmanuel, Serri, Karim, Skrobik, Yoanna, Hebert, Paul, St-Arnaud, Charles, Quiroz-Martinez, Hector, Mayette, Michaël, Heyland, Daren K
• Format: Article
• Language: English
• Subjects: Adult; Adults; Aged; Aged, 80 and over; Analysis; Blood pressure; Blood pressure measurement; Canada; Care and treatment; Clinical trials; Comorbidity; Comparative analysis; Critical care; Dosage and administration; Drug dosages; Drug therapy; Epidemiology; Female; Guidelines; Heart failure; Hospitals; Humans; Hypertension; Hypertension - drug therapy; Hypotension; Intensive care; Intensive Care Units; Male; Medical research; Medicine; Medicine and Health Sciences; Mercury; Middle Aged; Observational studies; Patients; People and Places; Physical Sciences; Physiological aspects; Practice guidelines (Medicine); Prospective Studies; Regression analysis; Regression models; Research and Analysis Methods; Sepsis; Severity of Illness Index; Studies; Therapy; Thoracic surgery; Variance analysis; Vasoconstrictor agents; Vasoconstrictor Agents - therapeutic use
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0167840

The optimal approach to titrate vasopressor therapy is unclear. Recent sepsis guidelines recommend a mean arterial pressure (MAP) target of 65 mmHg and higher for chronic hypertensive patients. As data emerge from clinical trials comparing blood pressure targets for vasopressor therapy, an accurate description of usual care is required to interpret study results. Our aim was to measure MAP values during vasopressor therapy in Canadian intensive care units (ICUs) and to compare these with stated practices and guidelines. In a multicenter prospective cohort study of critically ill adults with severe hypotension, we recorded MAP and vasopressor doses hourly. We investigated variability across patients and centres using multivariable regression models and Analysis of variance (ANOVA), respectively. We included data from 56 patients treated in 6 centers. The mean (standard deviation [SD]) age and Acute Physiology and Chronic Health Evaluation (APACHE) II score were 64 (14) and 25 (8). Half (28 of 56) of the patients were at least 65 years old, and half had chronic hypertension. The patient-averaged MAP while receiving vasopressors was 75 mm Hg (6) and the median (1st quartile, 3rd quartile) duration of vasopressor therapy was 43 hours (23, 84). MAP achieved was not associated with history of underlying hypertension (p = 0.46) but did vary by center (p