Changes in vasopressin use and outcomes in surgical intensive care unit patients with septic shock.
BACKGROUND
This study compares recent vasopressin use and outcomes to our early practice when vasopressin was introduced for septic shock.


METHODS
Charts of Surgical Intensive Care Unit (SICU) patients receiving vasopressin for septic shock in 2005-2006 (05-06 cohort,) were retrospectively reviewed. Demographics, APACHE II, hemodynamic variables, and vasoactive drug data were compared to a similar 1999-2000 cohort (99-00 cohort). Statistical analysis included general linear model, Chi-square, t-test, and Cox-regression (p < 0.05 considered significant).


RESULTS
Thirty-one SICU patients in the 05-06 cohort and twenty patients in the 99-00 cohort met study criteria. Age, weight, gender, intensive care length of stay and vasopressin treatment duration were similar in the two groups. APACHE II (23 +/- 7 versus 34 +/- 9), baseline vasopressin dose (2.2 +/- 1.4 units/hour versus 5.3 +/- 6.7 units/hour), and SICU survival rate (45% versus 15%) significantly changed between the two time periods (p < 0.01). The mean arterial pressure increased significantly from baseline at all measured time points in both groups (p < 0.05). Vasopressin and dopamine doses were significantly lower in the 05-06 cohort versus the 99-00 cohort (p < 0.05). By Cox regression analysis the survival function adjusted for APACHE II was significantly different between groups.


CONCLUSIONS
Vasopressin is recently used at lower doses and in less severe septic shock. Patients recently treated with vasopressin have a higher SICU survival rate than the survival rate when vasopressin was first introduced for septic shock.
Lupei
M I
MI
Department of Anesthesiology, School of Medicine, University of Minnesota 55455-0343, USA.
Beilman
G J
GJ
Chipman
J G
JG
Mann
H J
HJ
D018806:APACHE; D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D004298:Dopamine / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012772:Shock, Septic / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D013503:Surgery Department, Hospital; D016019:Survival Analysis; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000494:pharmacology / Q000627:therapeutic use*; D014667:Vasopressins / Q000494:pharmacology / Q000627:therapeutic use*
D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D004298:Dopamine