title: Early vasopressor use in critical injury is associated with mortality independent from volume status.
abstract: BACKGROUND
  Complications of excessive crystalloid after critical injury have increased interest in vasopressor support. However, it is hypothesized that vasopressor use in patients who are under-resuscitated is associated with death. We performed this study to determine whether volume status is associated with increased mortality in the critically injured exposed to early vasopressors.
  
  
  METHODS
  The intensive care unit database at a Level I center was queried for all adult admissions surviving for >24 hours from January 1, 2001, to December 31, 2008. Patients with spinal cord injury and severe traumatic brain injury were excluded. The vasopressor group [Vaso (+)] was exposed to dopamine, epinephrine, phenylephrine, norepinephrine, or arginine vasopressin within 24 hours of admission. Demographic and injury data were studied including intensive care unit admission central venous pressure. Hypovolemia [Hypov (+)] was considered an admission central venous pressure ≤8 mm Hg. The Vaso (+) group was analyzed to determine whether Hypov (+) was independently associated with death.
  
  
  RESULTS
  Of 1,349 eligible patients, 26% (351) were Vaso (+). Mortality was 43.6% (153) in the Vaso (+) versus 4.2% (42) in the Vaso (-) group (17.60 [12.10-25.60], <0.01). Vasopressor exposure was associated with death independent of injury severity. In Vaso (+) patients, Hypov (+) was not associated with mortality, whereas Emergency Department admission Glasgow Coma Scale ≤8 and multiple vasopressor use were.
  
  
  CONCLUSIONS
  Vasopressor exposure early after critical injury is independently associated with death and mortality is increased regardless of fluid status. Although it is not advisable to withhold support with impending cardiovascular collapse, use of any vasopressor during ongoing resuscitation should be approached with extreme caution regardless of volume status.
authors: LAC + USC Department of Surgery, Division of Trauma and Surgical Critical Care, Los Angeles, California, USA. plurad@usc.edu
authors: David S
authors: DS
authors: Plurad
authors: Peep
authors: P
authors: Talving
authors: Lydia
authors: L
authors: Lam
authors: Kenji
authors: K
authors: Inaba
authors: Donald
authors: D
authors: Green
authors: Demetrios
authors: D
authors: Demetriades
mesh_terms: D000328:Adult; D000368:Aged; D002496:Central Venous Pressure; D003422:Critical Care; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D020896:Hypovolemia / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014947:Wounds and Injuries / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult
chemical_list: D014662:Vasoconstrictor Agents