Timing of adjunctive vasopressin initiation for septic shock patients and hospital mortality: A multicentre observational study

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation Pub Date : 2024-12-01 DOI:10.1016/j.ccrj.2024.09.002

Kyle C. White MBBS MPH , Rahul Costa-Pinto FCICM , Anis Chaba MD , Philippa McIlroy MBBS FCICM , Siva Senthuran MBBS FCICM , Stephen Luke MBBS FCICM , Antony G. Attokaran MBBS FCICM , Peter Garrett MBBS FCICM , Mahesh Ramanan MBBS FCICM , Alexis Tabah MD FCICM , Kiran Shekar MBBS PhD , Kevin B. Laupland MS PhD , Hayden White FCICM PhD , James McCullough CFCICM MMed , Andrew Udy FCICM PhD , Glenn Eastwood MD PhD , Rinaldo Bellomo MD PhD

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引用次数: 0

Abstract

Objective

The optimal timing of vasopressin initiation as an adjunctive vasopressor remains unclear. We aimed to study the association between the timing of vasopressin commencement, pre-specified physiological parameters, and hospital mortality.

Design

We conducted a multicentre, retrospective, observational study.

Setting

Twelve ICUs in Queensland, Australia between January 2015 and December 2021.

Participants

Adult patients with septic shock who received vasopressin as an adjunctive vasopressor within 72 hours of ICU admission.

Main Outcome

Hospital mortality.

Results

Overall, 2747 patients fulfilled the inclusion criteria. Of these, 1850 (67%) started vasopressin within six hours of vasopressor therapy start, while 897 (33%) started vasopressin between six hours and 72 hours. APACHE III score, peak lactate, and creatinine were higher in the early start group. Early vasopressin start was independently associated with decreased hospital mortality (aOR = 0.69, 95% CI = 0.57-0.83). Vasopressin infusion start was also associated with an immediate decrease in the noradrenaline-equivalent dose regardless of timing. There was a statistically significant favourable breakpoint at vasopressin start for the course of arterial pH, lactate, heart rate and crystalloid infusion rate (p<0.001).

Conclusions

In patients with septic shock, early adjunctive vasopressin initiation was independently associated with lower hospital mortality. Vasopressin starting at any time was also associated with reduced tachycardia, acidosis, and hyperlactatemia.

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感染性休克患者辅助抗利尿激素起始时间和住院死亡率：一项多中心观察性研究

目的：抗利尿激素作为辅助抗利尿激素的最佳起始时间尚不清楚。我们的目的是研究抗利尿激素开始使用的时间、预先规定的生理参数和住院死亡率之间的关系。设计：我们进行了一项多中心、回顾性、观察性研究。背景：2015年1月至2021年12月期间，澳大利亚昆士兰州的12个icu。参与者：感染性休克的成年患者，在ICU入院72小时内接受血管加压素作为辅助血管加压素。主要结局：医院死亡率。结果：2747例患者符合纳入标准。其中，1850例（67%）在抗利尿激素治疗开始的6小时内开始使用抗利尿激素，而897例（33%）在6小时至72小时内开始使用抗利尿激素。早开始组APACHE III评分、乳酸峰值和肌酐较高。抗利尿激素早期使用与住院死亡率降低独立相关（aOR = 0.69, 95% CI = 0.57-0.83）。抗利尿激素输注开始也与去甲肾上腺素当量剂量的立即减少有关，与时间无关。在动脉pH值、乳酸、心率和晶体输注速率的过程中，抗利尿激素开始时有一个具有统计学意义的有利断点(结论：在感染性休克患者中，早期辅助抗利尿激素开始与较低的住院死亡率独立相关。任何时间开始的抗利尿激素也与心动过速、酸中毒和高乳酸血症的减少有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care and Resuscitation CRITICAL CARE MEDICINE-

CiteScore

7.70

自引率

3.40%

发文量

审稿时长

>12 weeks

期刊介绍： ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines. The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world. The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.