Critical Care and Shock

North American Survey of Vasopressor and Inotrope Use in Severe Sepsis and Septic Shock

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Objective: The primary objective of this study was to characterize how vasopressor and inotropic agents are prescribed and administered in the hemodynamic management of sepsis. Secondary objectives were 1) to evaluate adherence with published guidelines to identify areas of deviation and 2) to describe pharmacists’ perceived incidence of adverse drug reactions (ADRs) of vasopressors and inotropes.

Design and setting: Web-based survey.

Patients and participants: Critical care pharmacists.

Interventions: An email invitation was sent to critical care pharmacists asking them to complete a web-based survey. The survey opened September 29, 2004 and closed March 4, 2005.

Measurements and results: Of 1065 pharmacists, 235 (22.1%) responded to the survey. Median hospital and ICU size were 451 and 20 beds, respectively. Primary types of ICUs included general (42.1%), medical (28.5%), surgical/trauma (18.3%), cardiac (9.8%), and other (1.3%). Independent of pulmonary artery catheter (PAC) use, the most common initial vasopressor choice in surgical/trauma ICUs was norepinephrine. In the other ICUs, the most common first-line agent was norepinephrine if a PAC was present and dopamine if a PAC was not present. The most common dosage regimen of vasopressin was a continuous infusion of 0.04 units/min (49.8%). The most commonly used inotrope was dobutamine. Respondents reported using inotropes either sometimes (48.1%) or rarely (34.0%), with therapy continuing 24–48 (54.5%) or 48–72 (26.0%) hours. Commonly associated agents with specific adverse effects included dopamine with tachycardia and norepinephrine with digital ischemia. Much variability was shown in drug concentrations and various dosages of vasopressors and inotropes between institutions.

Conclusions: Despite published guidelines, vasopressor and inotrope use in hemodynamic management of patients with sepsis and septic shock displayed much variability. Perceived incidence of ADRs for these agents also demonstrated inconsistency among respondents. National organizations need to develop recommendations for standardization of concentrations of continuous infusion medications in the ICU.