Vasopressor Use for Severe Hypotension-A Multicentre Prospective Observational Study

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...

Full description

Saved in:
Bibliographic Details
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
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c725t-b6cb0f0dfb297e9af38d587b93ac1070a0f5552866d9cffa21d2c6e9de377e553
cites cdi_FETCH-LOGICAL-c725t-b6cb0f0dfb297e9af38d587b93ac1070a0f5552866d9cffa21d2c6e9de377e553
container_end_page e0167840
container_issue 1
container_start_page e0167840
container_title PloS one
container_volume 12
creator 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
description 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
doi_str_mv 10.1371/journal.pone.0167840
format article
fullrecord <record><control><sourceid>gale_plos_</sourceid><recordid>TN_cdi_plos_journals_1860295619</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A478287064</galeid><doaj_id>oai_doaj_org_article_416f5d18db3a4431b3d2f7c64d9d1794</doaj_id><sourcerecordid>A478287064</sourcerecordid><originalsourceid>FETCH-LOGICAL-c725t-b6cb0f0dfb297e9af38d587b93ac1070a0f5552866d9cffa21d2c6e9de377e553</originalsourceid><addsrcrecordid>eNqNk11v0zAUhiMEYqPwDxBEQkJw0eKP2E5ukKoJWKWhIrrt1nLs4zZTGoc4qei_x2mzqUG7mHLhyH7O6_ccnxNFbzGaYSrwlzvXNZUqZ7WrYIYwF2mCnkXnOKNkygmiz0_-z6JX3t8hxGjK-cvojKQYCcrEeXR9q7yrG_DeNfGNh9iGdQU7aCC-3NeuhcoXrprO459d2RYaqjac_Gqcr0G3xQ7iZe6h2ak2UKqMV21n9q-jF1aVHt4M6yS6-f7t-uJyerX8sbiYX021IKyd5lznyCJjc5IJyJSlqWGpyDOqdPCHFLKMMRIsm0xbqwg2RHPIDFAhgDE6id4fdevSeTkUxEucckQyxkP6k2hxJIxTd7Juiq1q9tKpQh42XLOWqglplSATzC0zODU5VUlCcU4NsULzxGQGiywJWl-H27p8C-ZQClWORMcnVbGRa7eTjCQZSnoznwaBxv3pwLdyW3gNZakqcN3Bd0pplnD6FBSzNBG0Rz_8hz5eiIFaq5BrUVkXLOpeVM4TkZJUIN6nOHuECp-BbaFDo9ki7I8CPo8CAtPC33atOu_lYvX76ezydsx-PGE3oMp2413Z9V3mx2ByBHVoSd-AfXgPjGQ_J_fVkP2cyGFOQti707d8CLofDPoPvuoNkA</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1860295619</pqid></control><display><type>article</type><title>Vasopressor Use for Severe Hypotension-A Multicentre Prospective Observational Study</title><source>Open Access: PubMed Central</source><source>Publicly Available Content Database</source><creator>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</creator><contributor>Gallyas, Ferenc</contributor><creatorcontrib>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 ; Gallyas, Ferenc</creatorcontrib><description>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&lt;0.001). In this multicenter, prospective observational study, the patient-level average MAP while receiving vasopressors for severe hypotension was 75 mmHg, approximately 10 mmHg above current recommendations and stated practices. Moreover, our results do not support the notion that clinicians tailor vasopressor therapy to individual patient characteristics such as underlying chronic hypertension but MAP achieved while receiving vasopressors varied by site.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0167840</identifier><identifier>PMID: 28107357</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>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</subject><ispartof>PloS one, 2017-01, Vol.12 (1), p.e0167840-e0167840</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Lamontagne et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2017 Lamontagne et al 2017 Lamontagne et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c725t-b6cb0f0dfb297e9af38d587b93ac1070a0f5552866d9cffa21d2c6e9de377e553</citedby><cites>FETCH-LOGICAL-c725t-b6cb0f0dfb297e9af38d587b93ac1070a0f5552866d9cffa21d2c6e9de377e553</cites><orcidid>0000-0002-0360-3427</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/1860295619/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/1860295619?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25752,27923,27924,37011,37012,44589,53790,53792,74897</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28107357$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Gallyas, Ferenc</contributor><creatorcontrib>Lamontagne, Francois</creatorcontrib><creatorcontrib>Cook, Deborah J</creatorcontrib><creatorcontrib>Meade, Maureen O</creatorcontrib><creatorcontrib>Seely, Andrew</creatorcontrib><creatorcontrib>Day, Andrew G</creatorcontrib><creatorcontrib>Charbonney, Emmanuel</creatorcontrib><creatorcontrib>Serri, Karim</creatorcontrib><creatorcontrib>Skrobik, Yoanna</creatorcontrib><creatorcontrib>Hebert, Paul</creatorcontrib><creatorcontrib>St-Arnaud, Charles</creatorcontrib><creatorcontrib>Quiroz-Martinez, Hector</creatorcontrib><creatorcontrib>Mayette, Michaël</creatorcontrib><creatorcontrib>Heyland, Daren K</creatorcontrib><title>Vasopressor Use for Severe Hypotension-A Multicentre Prospective Observational Study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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&lt;0.001). In this multicenter, prospective observational study, the patient-level average MAP while receiving vasopressors for severe hypotension was 75 mmHg, approximately 10 mmHg above current recommendations and stated practices. Moreover, our results do not support the notion that clinicians tailor vasopressor therapy to individual patient characteristics such as underlying chronic hypertension but MAP achieved while receiving vasopressors varied by site.</description><subject>Adult</subject><subject>Adults</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis</subject><subject>Blood pressure</subject><subject>Blood pressure measurement</subject><subject>Canada</subject><subject>Care and treatment</subject><subject>Clinical trials</subject><subject>Comorbidity</subject><subject>Comparative analysis</subject><subject>Critical care</subject><subject>Dosage and administration</subject><subject>Drug dosages</subject><subject>Drug therapy</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Guidelines</subject><subject>Heart failure</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension - drug therapy</subject><subject>Hypotension</subject><subject>Intensive care</subject><subject>Intensive Care Units</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Mercury</subject><subject>Middle Aged</subject><subject>Observational studies</subject><subject>Patients</subject><subject>People and Places</subject><subject>Physical Sciences</subject><subject>Physiological aspects</subject><subject>Practice guidelines (Medicine)</subject><subject>Prospective Studies</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Research and Analysis Methods</subject><subject>Sepsis</subject><subject>Severity of Illness Index</subject><subject>Studies</subject><subject>Therapy</subject><subject>Thoracic surgery</subject><subject>Variance analysis</subject><subject>Vasoconstrictor agents</subject><subject>Vasoconstrictor Agents - therapeutic use</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNqNk11v0zAUhiMEYqPwDxBEQkJw0eKP2E5ukKoJWKWhIrrt1nLs4zZTGoc4qei_x2mzqUG7mHLhyH7O6_ccnxNFbzGaYSrwlzvXNZUqZ7WrYIYwF2mCnkXnOKNkygmiz0_-z6JX3t8hxGjK-cvojKQYCcrEeXR9q7yrG_DeNfGNh9iGdQU7aCC-3NeuhcoXrprO459d2RYaqjac_Gqcr0G3xQ7iZe6h2ak2UKqMV21n9q-jF1aVHt4M6yS6-f7t-uJyerX8sbiYX021IKyd5lznyCJjc5IJyJSlqWGpyDOqdPCHFLKMMRIsm0xbqwg2RHPIDFAhgDE6id4fdevSeTkUxEucckQyxkP6k2hxJIxTd7Juiq1q9tKpQh42XLOWqglplSATzC0zODU5VUlCcU4NsULzxGQGiywJWl-H27p8C-ZQClWORMcnVbGRa7eTjCQZSnoznwaBxv3pwLdyW3gNZakqcN3Bd0pplnD6FBSzNBG0Rz_8hz5eiIFaq5BrUVkXLOpeVM4TkZJUIN6nOHuECp-BbaFDo9ki7I8CPo8CAtPC33atOu_lYvX76ezydsx-PGE3oMp2413Z9V3mx2ByBHVoSd-AfXgPjGQ_J_fVkP2cyGFOQti707d8CLofDPoPvuoNkA</recordid><startdate>20170120</startdate><enddate>20170120</enddate><creator>Lamontagne, Francois</creator><creator>Cook, Deborah J</creator><creator>Meade, Maureen O</creator><creator>Seely, Andrew</creator><creator>Day, Andrew G</creator><creator>Charbonney, Emmanuel</creator><creator>Serri, Karim</creator><creator>Skrobik, Yoanna</creator><creator>Hebert, Paul</creator><creator>St-Arnaud, Charles</creator><creator>Quiroz-Martinez, Hector</creator><creator>Mayette, Michaël</creator><creator>Heyland, Daren K</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-0360-3427</orcidid></search><sort><creationdate>20170120</creationdate><title>Vasopressor Use for Severe Hypotension-A Multicentre Prospective Observational Study</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c725t-b6cb0f0dfb297e9af38d587b93ac1070a0f5552866d9cffa21d2c6e9de377e553</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Adults</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis</topic><topic>Blood pressure</topic><topic>Blood pressure measurement</topic><topic>Canada</topic><topic>Care and treatment</topic><topic>Clinical trials</topic><topic>Comorbidity</topic><topic>Comparative analysis</topic><topic>Critical care</topic><topic>Dosage and administration</topic><topic>Drug dosages</topic><topic>Drug therapy</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Guidelines</topic><topic>Heart failure</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension - drug therapy</topic><topic>Hypotension</topic><topic>Intensive care</topic><topic>Intensive Care Units</topic><topic>Male</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Mercury</topic><topic>Middle Aged</topic><topic>Observational studies</topic><topic>Patients</topic><topic>People and Places</topic><topic>Physical Sciences</topic><topic>Physiological aspects</topic><topic>Practice guidelines (Medicine)</topic><topic>Prospective Studies</topic><topic>Regression analysis</topic><topic>Regression models</topic><topic>Research and Analysis Methods</topic><topic>Sepsis</topic><topic>Severity of Illness Index</topic><topic>Studies</topic><topic>Therapy</topic><topic>Thoracic surgery</topic><topic>Variance analysis</topic><topic>Vasoconstrictor agents</topic><topic>Vasoconstrictor Agents - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lamontagne, Francois</creatorcontrib><creatorcontrib>Cook, Deborah J</creatorcontrib><creatorcontrib>Meade, Maureen O</creatorcontrib><creatorcontrib>Seely, Andrew</creatorcontrib><creatorcontrib>Day, Andrew G</creatorcontrib><creatorcontrib>Charbonney, Emmanuel</creatorcontrib><creatorcontrib>Serri, Karim</creatorcontrib><creatorcontrib>Skrobik, Yoanna</creatorcontrib><creatorcontrib>Hebert, Paul</creatorcontrib><creatorcontrib>St-Arnaud, Charles</creatorcontrib><creatorcontrib>Quiroz-Martinez, Hector</creatorcontrib><creatorcontrib>Mayette, Michaël</creatorcontrib><creatorcontrib>Heyland, Daren K</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing &amp; Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological &amp; Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science &amp; Engineering Collection</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central</collection><collection>Advanced Technologies &amp; Aerospace Collection</collection><collection>Agricultural &amp; Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>ProQuest Materials Science Database</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Meteorological &amp; Geoastrophysical Abstracts - Academic</collection><collection>ProQuest Engineering Collection</collection><collection>Biological Sciences</collection><collection>Agriculture Science Database</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>ProQuest Engineering Database</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>ProQuest Advanced Technologies &amp; Aerospace Database</collection><collection>ProQuest Advanced Technologies &amp; Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lamontagne, Francois</au><au>Cook, Deborah J</au><au>Meade, Maureen O</au><au>Seely, Andrew</au><au>Day, Andrew G</au><au>Charbonney, Emmanuel</au><au>Serri, Karim</au><au>Skrobik, Yoanna</au><au>Hebert, Paul</au><au>St-Arnaud, Charles</au><au>Quiroz-Martinez, Hector</au><au>Mayette, Michaël</au><au>Heyland, Daren K</au><au>Gallyas, Ferenc</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vasopressor Use for Severe Hypotension-A Multicentre Prospective Observational Study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-01-20</date><risdate>2017</risdate><volume>12</volume><issue>1</issue><spage>e0167840</spage><epage>e0167840</epage><pages>e0167840-e0167840</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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&lt;0.001). In this multicenter, prospective observational study, the patient-level average MAP while receiving vasopressors for severe hypotension was 75 mmHg, approximately 10 mmHg above current recommendations and stated practices. Moreover, our results do not support the notion that clinicians tailor vasopressor therapy to individual patient characteristics such as underlying chronic hypertension but MAP achieved while receiving vasopressors varied by site.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28107357</pmid><doi>10.1371/journal.pone.0167840</doi><tpages>e0167840</tpages><orcidid>https://orcid.org/0000-0002-0360-3427</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 1932-6203
ispartof PloS one, 2017-01, Vol.12 (1), p.e0167840-e0167840
issn 1932-6203
1932-6203
language eng
recordid cdi_plos_journals_1860295619
source Open Access: PubMed Central; Publicly Available Content Database
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
title Vasopressor Use for Severe Hypotension-A Multicentre Prospective Observational Study
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-10T22%3A53%3A16IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Vasopressor%20Use%20for%20Severe%20Hypotension-A%20Multicentre%20Prospective%20Observational%20Study&rft.jtitle=PloS%20one&rft.au=Lamontagne,%20Francois&rft.date=2017-01-20&rft.volume=12&rft.issue=1&rft.spage=e0167840&rft.epage=e0167840&rft.pages=e0167840-e0167840&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0167840&rft_dat=%3Cgale_plos_%3EA478287064%3C/gale_plos_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c725t-b6cb0f0dfb297e9af38d587b93ac1070a0f5552866d9cffa21d2c6e9de377e553%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1860295619&rft_id=info:pmid/28107357&rft_galeid=A478287064&rfr_iscdi=true