Early vasopressin reduces incidence of new onset arrhythmias

Reardon, David P.; DeGrado, Jeremy; Anger, Kevin E.; Szumita, Paul M.

doi:10.1016/j.jcrc.2014.03.005

Cited by 37 publications

(53 citation statements)

References 15 publications

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“…For example, respondents were less likely to recommend vasopressin as a second‐line vasopressor to raise mean arterial pressure when cost was considered, likely reflecting the preference for a less costly option with epinephrine when the Surviving Sepsis Campaign Guideline recommendation supported either agent . However, it is notable that over two‐thirds of pharmacists still recommended vasopressin even when considering cost and lower levels of evidence, suggesting their practice bias may be influenced by strong personal beliefs regarding physiological bases for vasopressin use but a lack of or controversial supporting data . The scenarios for which there are physiological bases for vasopressin use may represent opportunities for restrictions in the short‐term and research in the intermediate‐to‐long term.…”

Section: Discussionmentioning

confidence: 99%

Perceptions regarding vasopressin use and practices in septic shock, and cost containment strategies

Hammond

Rech

Daley

et al. 2019

J Am Coll Clin Pharm

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Background Clinician preferences and practices regarding appropriate vasopressin use in light of its increased acquisition cost secondary to rebranding has not been evaluated or described since the most recent iteration of the Surviving Sepsis Campaign Guideline was published. Objective To assess vasopressin cost containment initiatives and pharmacists' opinions regarding appropriate vasopressin use. Methods A scenario‐based survey was distributed to critical care and emergency medicine pharmacists. Responses were characterized using frequency and descriptive statistics. Categorical variables between those who implemented changes (Vasopressin Cost Consideration) and those who did not (Usual Care) were compared using chi‐square or Fisher's exact tests. McNemar's test was used to compare responses in clinical scenarios between Vasopressin Cost Consideration and Usual Care groups. Results Among 1757 pharmacists surveyed, 200 (11.3%) responded. When respondents considered vasopressin cost and evidence (vs evidence alone), fewer respondents would use vasopressin adjunctively with norepinephrine (21% vs 26.6%, P = 0.031), to raise mean arterial pressure compared with epinephrine (65.2% vs 72.3%, P = 0.012), or to reduce norepinephrine infusion rates (71.4% vs 81.4%, P < 0.001), but would use with steroids (62.4% vs 28.3%, P < 0.001). Most (72%) respondents had implemented vasopressin cost containment and/or education initiatives. The Vasopressin Cost Consideration group respondents were more likely to initiate vasopressin at 0.03 units/minute without titrating (47.9% vs 33.9%, P = 0.045). Conclusion Since vasopressin was generically rebranded, most institutions have implemented at least one initiative to reduce vasopressin use and/or educate clinicians about its appropriate use. When vasopressin acquisition costs were considered, pharmacists recommended its use less frequently, particularly in clinical scenarios where its use is controversial.

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Section: Discussionmentioning

confidence: 99%

Perceptions regarding vasopressin use and practices in septic shock, and cost containment strategies

Hammond

Rech

Daley

et al. 2019

J Am Coll Clin Pharm

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“…It is speculated that one of the mechanisms of genesis of AF could be an excess of catecholamines or an increased sensitivity to them [19]. Vasopressin could also trigger AF [20], although it may have a lower ability to induce arrhythmias in critical patients [21, 22]. In our study, no patient in vasopressin use developed AF (Table 2 and Figure 1).…”

Section: Discussionmentioning

confidence: 55%

Factors Associated with the Incidence and Severity of New-Onset Atrial Fibrillation in Adult Critically Ill Patients

Duarte

Leichtweis

Andriolo

et al. 2017

Critical Care Research and Practice

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Background Acute Atrial Fibrillation (AF) is common in critically ill patients, with significant morbidity and mortality; however, its incidence and severity in Intensive Care Units (ICUs) from low-income countries are poorly studied. Additionally, impact of vasoactive drugs on its incidence and severity is still not understood. This study aimed to assess epidemiology and risk factors for acute new-onset AF in critically ill adult patients and the role of vasoactive drugs. Method Cohort performed in seven general ICUs (including cardiac surgery) in three cities in Paraná State (southern Brazil) for 45 days. Patients were followed until hospital discharge. Results Among 430 patients evaluated, the incidence of acute new-onset AF was 11.2%. Patients with AF had higher ICU and hospital mortality. Vasoactive drugs use (norepinephrine and dobutamine) was correlated with higher incidence of AF and higher mortality in patients with AF; vasopressin (though used in few patients) had no effect on development of AF. Conclusions In general ICU patients, incidence of new-onset AF was 11.2% with a high impact on morbidity and mortality, particularly associated with the presence of Acute Renal Failure. The use of vasoactive drugs (norepinephrine and dobutamine) could lead to a higher incidence of new-onset AF-associated morbidity and mortality.

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“…Early initiation of VP therapy could decrease the incidence of new onset arrhythmias [3]. VP may act on the baroreceptor reflex to control the accelerator center of the cardiac brainstem.…”

Section: Discussionmentioning

confidence: 99%

Combined use of high doses of vasopressin and corticosteroids in a patient with Crohn’s disease with refractory septic shock after intestinal perforation: a case report

et al. 2017

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BackgroundIn this article, we present a clinical case of refractory septic shock resulting from intestinal perforation treated with high doses of vasopressin and hydrocortisone during emergency surgery.The use of such high doses of vasopressin for this type of shock is not described in the literature.Case presentationA 49-year-old white woman with grade III obesity, Crohn’s disease, and an intestinal perforation presented with refractory septic shock. Initially, a low dose of vasopressin was used. Then, the dosage was increased to 0.4 U/minute; in the literature, this is defined as “salvage therapy.” This therapy consists of an initial load followed by a continuous infusion of hydrocortisone.ConclusionsThe significant increase in her cardiac index and stroke volume index resulted in an improvement in peripheral resistance, gas exchange, and urine output and a decrease in her heart rate, interleukin-6 level, and tumor necrosis factor-α level. The administration of high doses of vasopressin and corticosteroids was demonstrated to be safe for the immune system, to reduce the systemic inflammatory response, and to have direct cardiovascular effects. Further studies are required to examine the use of vasopressin as an initial vasopressor as well as its use in high dosages and in combination with corticosteroids.

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Early vasopressin reduces incidence of new onset arrhythmias

Cited by 37 publications

References 15 publications

Perceptions regarding vasopressin use and practices in septic shock, and cost containment strategies

Perceptions regarding vasopressin use and practices in septic shock, and cost containment strategies

Factors Associated with the Incidence and Severity of New-Onset Atrial Fibrillation in Adult Critically Ill Patients

Combined use of high doses of vasopressin and corticosteroids in a patient with Crohn’s disease with refractory septic shock after intestinal perforation: a case report

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