Treatment with vasoactive drugs and outcomes in surgical critically ill patients: The results from the THAI-SICU study

© 2016, Medical Association of Thailand. All rights reserved. Objective: The purpose of this study is to assess the impact of the use of vasoactive drugs on morbidity and mortality in surgical critically ill patients. Material and Method: We conducted a multi-center prospective observational study i...

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Main Authors: Thammasak Thawitsri, Kaweesak Chittawatanarat, Kanya Kumwilaisak, Somrat Charuluxananan
Format: Journal
Published: 2018
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http://cmuir.cmu.ac.th/jspui/handle/6653943832/56068
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spelling th-cmuir.6653943832-560682018-09-05T03:08:31Z Treatment with vasoactive drugs and outcomes in surgical critically ill patients: The results from the THAI-SICU study Thammasak Thawitsri Kaweesak Chittawatanarat Kanya Kumwilaisak Somrat Charuluxananan Medicine © 2016, Medical Association of Thailand. All rights reserved. Objective: The purpose of this study is to assess the impact of the use of vasoactive drugs on morbidity and mortality in surgical critically ill patients. Material and Method: We conducted a multi-center prospective observational study in Thai university-based surgical intensive care units (SICU) over a 22-month period. Patient data were recorded by case record form in 3 main phases: admission, daily and discharge. Data collection included patient characteristics, pattern of vasoactive drugs use, and outcomes. Results: Nine university-based SICU comprising 4,652 patients were included in the study. The vasopressor exposed patient group had 1,155 patients (24.8%). Either vasopressor or inotrope exposed group demonstrated significantly higher ICU mortality, 28-day mortality and new arrhythmia than the non-exposed group (p<0.001). In multivariable analysis, norepinephrine or epinephrine significantly increased risks of all unfavorable outcomes while dopamine significantly increased only new arrhythmia (OR 1.44; 95% CI 1.02-2.02, p = 0.036) in vasopressor-exposed patients. Epinephrine had the highest risk of all unfavorable outcomes with an OR 3.17; 95% CI 2.10-4.78, (p<0.001) for ICU mortality, OR 2.62; 95% CI 1.73-3.97, (p<0.001) for 28-day mortality, and OR of 1.77; 95% CI 1.13-2.75, (p = 0.012) for new arrhythmia. Neither dobutamine nor milrinone showed any significant results in inotrope exposed patients. Conclusion: Vasoactive drug exposed patient groups had significantly higher incidence of new arrhythmia, ICU mortality, and 28-day mortality. Epinephrine exposure was associated with the highest risk of unfavorable outcomes. Further information from well-designed studies is needed to justify the most appropriate use of vasoactive drugs. 2018-09-05T03:08:31Z 2018-09-05T03:08:31Z 2016-09-01 Journal 01252208 2-s2.0-85012111027 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85012111027&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/56068
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Medicine
spellingShingle Medicine
Thammasak Thawitsri
Kaweesak Chittawatanarat
Kanya Kumwilaisak
Somrat Charuluxananan
Treatment with vasoactive drugs and outcomes in surgical critically ill patients: The results from the THAI-SICU study
description © 2016, Medical Association of Thailand. All rights reserved. Objective: The purpose of this study is to assess the impact of the use of vasoactive drugs on morbidity and mortality in surgical critically ill patients. Material and Method: We conducted a multi-center prospective observational study in Thai university-based surgical intensive care units (SICU) over a 22-month period. Patient data were recorded by case record form in 3 main phases: admission, daily and discharge. Data collection included patient characteristics, pattern of vasoactive drugs use, and outcomes. Results: Nine university-based SICU comprising 4,652 patients were included in the study. The vasopressor exposed patient group had 1,155 patients (24.8%). Either vasopressor or inotrope exposed group demonstrated significantly higher ICU mortality, 28-day mortality and new arrhythmia than the non-exposed group (p<0.001). In multivariable analysis, norepinephrine or epinephrine significantly increased risks of all unfavorable outcomes while dopamine significantly increased only new arrhythmia (OR 1.44; 95% CI 1.02-2.02, p = 0.036) in vasopressor-exposed patients. Epinephrine had the highest risk of all unfavorable outcomes with an OR 3.17; 95% CI 2.10-4.78, (p<0.001) for ICU mortality, OR 2.62; 95% CI 1.73-3.97, (p<0.001) for 28-day mortality, and OR of 1.77; 95% CI 1.13-2.75, (p = 0.012) for new arrhythmia. Neither dobutamine nor milrinone showed any significant results in inotrope exposed patients. Conclusion: Vasoactive drug exposed patient groups had significantly higher incidence of new arrhythmia, ICU mortality, and 28-day mortality. Epinephrine exposure was associated with the highest risk of unfavorable outcomes. Further information from well-designed studies is needed to justify the most appropriate use of vasoactive drugs.
format Journal
author Thammasak Thawitsri
Kaweesak Chittawatanarat
Kanya Kumwilaisak
Somrat Charuluxananan
author_facet Thammasak Thawitsri
Kaweesak Chittawatanarat
Kanya Kumwilaisak
Somrat Charuluxananan
author_sort Thammasak Thawitsri
title Treatment with vasoactive drugs and outcomes in surgical critically ill patients: The results from the THAI-SICU study
title_short Treatment with vasoactive drugs and outcomes in surgical critically ill patients: The results from the THAI-SICU study
title_full Treatment with vasoactive drugs and outcomes in surgical critically ill patients: The results from the THAI-SICU study
title_fullStr Treatment with vasoactive drugs and outcomes in surgical critically ill patients: The results from the THAI-SICU study
title_full_unstemmed Treatment with vasoactive drugs and outcomes in surgical critically ill patients: The results from the THAI-SICU study
title_sort treatment with vasoactive drugs and outcomes in surgical critically ill patients: the results from the thai-sicu study
publishDate 2018
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85012111027&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/56068
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