Extensive Variability in Vasoactive Agent Therapy

Pei, Xianbo; Ma, Pan; Li, Jianguo; Du, Zhenhong; Zhou, Qing; Lu, Zhao; Luo, Yun; Hu, Bo

doi:10.4103/0366-6999.155064

Cited by 8 publications

(3 citation statements)

References 30 publications

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“…A nationwide survey of Chinese ICUs reported that 70.8% of ICU physicians selected norepinephrine and 27.6% selected dopamine as the first choice of vasopressor for septic shock patients; however, the actual usage level was not clear. [ 13 ] In the same study, dopamine was selected by 73.4% of physicians for hypovolemic shock and 68.3% of physicians for cardiogenic shock as the first-choice vasopressor. Dopamine has previously been recommended as the first choice for cardiogenic shock.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Current Interventions in Shock Patients in Chinese Emergency Departments

Guo¹,

Chen²,

Yu³

2017

Chinese Medical Journal

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Background:Shock is a life-threatening condition in emergency departments (EDs) and is associated with a high mortality; however, its clinical characteristics and current interventions in China are seldom reported. This study investigated the clinical characteristics and current interventions of shock patients in Chinese EDs.Methods:This multicenter prospective cohort study was conducted in the EDs of 33 academic hospitals in 16 Chinese provinces. Adult shock patients were enrolled from December 2013 to April 2014. Age, sex, comorbidities, shock subtype, and vital signs were recorded on ED arrival; details of subsequent interventions and treatments were added. We compared those data between survivors and nonsurvivors. All patients were followed up for 3 days. The primary outcome was 3-day mortality. Binary logistic regression analysis identified the independent predictors of that mortality.Results:We enrolled 1095 shock patients. The 3-day mortality was 27.5%, 36.3%, and 29.0%, respectively, in the whole cohort and for cardiogenic and septic shock. Within the first 24 h, 1039 patients (94.9%) were admitted to the Intensive Care Unit. Use of bicarbonate, epinephrine, and dopamine is an independent predictor for mortality. Hemorrhage and trauma (39.1%), along with sepsis (40.4%) were the most commonly observed causes of shock in the ED. In nondiabetic patients with cardiogenic shock, 3-day mortality was 69.2% for patients needing glucose control — much higher than in those not needing glucose control (30.0%, P = 0.01). Hydroxyethyl starch (HES) was applied in 29.6% of septic shock patients, and the mortality of septic patients who received HES was much higher than those who did not (38.2% vs. 25.1%, P = 0.006).Conclusions:In China, short-term mortality of shock patients in EDs is still high, especially among those with cardiogenic and septic shock. HES application needs to be restricted — particularly in septic shock patients.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Current Interventions in Shock Patients in Chinese Emergency Departments

Guo¹,

Chen²,

Yu³

2017

Chinese Medical Journal

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“…The subgroup analysis of a randomized controlled trial showed that norepinephrine decreased mortality compared with dopamine in cardiogenic shock, but no difference in mortality was observed in hypovolemic shock [12]. These previous studies comparing norepinephrine and dopamine have investigated patients with sepsis and post-cardiac surgery, based on which, physicians have selected perioperative vasoconstrictors for their patients [15]. Furthermore, studies comparing the effect of norepinephrine and dopamine in noncardiac surgery settings with relatively low mortality are limited [9].…”

Section: Introductionmentioning

confidence: 99%

Postoperative norepinephrine versus dopamine in patients undergoing noncardiac surgery: a propensity-matched analysis using a nationwide intensive care database

Aoki

Nakajima

Sugimura

et al. 2023

Korean J Anesthesiol

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Background: Catecholamine choices, such as norepinephrine and dopamine, for perioperative blood pressure control are essential for anesthesiologists and intensivists. However, studies in noncardiac surgery are limited. Therefore, we aimed to evaluate the effect of postoperative norepinephrine and dopamine on clinical outcomes in adult patients who underwent noncardiac surgery by analyzing a nationwide intensive care patient database. Methods:This study was a multicenter retrospective study using the Japanese Intensive care PAtient Database (JIPAD). Adult patients from the JIPAD who received norepinephrine or dopamine within 24 hours after noncardiac surgery between 2018 and 2020 were included. We compared the norepinephrine and dopamine groups using one-to-one propensity score matching analysis. The primary outcome was in-hospital mortality. Secondary outcomes were intensive care unit (ICU) mortality, length of hospital stay, and length of ICU stay. Results:The 6236 eligible patients from 69 ICUs were allocated to the norepinephrine group (n = 4652) or the dopamine group (n = 1584). Propensity score matching created a matched cohort of 1230 pairs. After propensity score matching, in-hospital mortality did not differ between the two groups (risk difference, 0.41%; 95% confidence interval, −1.15 to 1.96; p = 0.61). Among the secondary outcomes, only the length of ICU stay was significantly shorter in the norepinephrine group than that in the dopamine group (median length, 3 days versus 4 days, respectively; p < 0.001).

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“…While these agents are commonly used within the ICU to treat circulatory failure, previous studies have shown that heterogeneity in the patient background and variability in physician behavior results in significant variability in their use [12,[15][16][17][18][19]. Information about factors contributing to the variability in physicians' choice of drugs is still scarce.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the Association Between the Number of Intensivists and the Use of Cardiovascular Agonists: An Ecological Study Using Data From National Databases of Japan

Ono,

Shimizu

2023

Cureus

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BackgroundPrevious studies have demonstrated a correlation between management by intensivists and a decrease in hospital stay and mortality, yet the underlying reason remains unknown. Using open data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) and other databses, the present study aimed to explore the relationship between inotrope and vasoconstrictor use and the number of intensivists. Materials and methodsCardiovascular agonists listed in the 2020 NDB for which the total dose was known were included for analysis. Trends in cardiovascular agonist use over six years were then graphically assessed, and a linear regression model with the use of each target drug per prefecture as the objective variable in the 2020 data was created to analyze the impact of intensivists on drug use. ResultsA total of 61 drugs were classified into eight groups based on their composition, and drug use in each of the 47 prefectures was tabulated. Both the rate of use and cost showed a yearly decrease for dopamine but a yearly increase for norepinephrine. Multivariable analysis indicated that the number of intensivists was only significant for dopamine, which had a coefficient of -310 (95% CI: -548 to -72, p = 0.01) but that no such trend was evident for the other drugs. ConclusionsThe results demonstrated that an increasing number of intensivists in each prefecture correlated with decreasing use of dopamine, possibly explaining the improved outcomes observed in closed ICUs led by intensivists. Further research is warranted to establish causality.

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Extensive Variability in Vasoactive Agent Therapy

Cited by 8 publications

References 30 publications

Clinical Characteristics and Current Interventions in Shock Patients in Chinese Emergency Departments

Clinical Characteristics and Current Interventions in Shock Patients in Chinese Emergency Departments

Postoperative norepinephrine versus dopamine in patients undergoing noncardiac surgery: a propensity-matched analysis using a nationwide intensive care database

Analysis of the Association Between the Number of Intensivists and the Use of Cardiovascular Agonists: An Ecological Study Using Data From National Databases of Japan

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