title: Vasopressor Use for Severe Hypotension-A Multicentre Prospective Observational Study.
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<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.
authors.affiliation: Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.|Centre de Recherche du CHU de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Francois
authors.identifier: 0000-0002-0360-3427
authors.initials: F
authors.lastname: Lamontagne
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.|Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.|Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Maureen O
authors.initials: MO
authors.lastname: Meade
authors.affiliation: Thoracic Surgery and Critical Care Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Seely
authors.affiliation: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Day
authors.affiliation: Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Canada.|Centre hospitalier affilié universitaire régional de Trois-Rivières.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Charbonney
authors.affiliation: Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Canada.
authors.forename: Karim
authors.initials: K
authors.lastname: Serri
authors.affiliation: McGill University, Montreal, Quebec, Canada.
authors.forename: Yoanna
authors.initials: Y
authors.lastname: Skrobik
authors.affiliation: Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Hebert
authors.affiliation: Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Charles
authors.initials: C
authors.lastname: St-Arnaud
authors.affiliation: Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Hector
authors.initials: H
authors.lastname: Quiroz-Martinez
authors.affiliation: Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Michaël
authors.initials: M
authors.lastname: Mayette
authors.affiliation: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents