THE VASOPRESSOR USE IN CARDIAC INTENSIVE CARE UNIT: 7 YEARS COHORT STUDY

Learning Objectives: The use of vasopressor was common in cardiac intensive care unit (CICU). Due to the lack of conclusive evidence in superiority in efficacy among various types of vasopressors, the choice of vasopressor use mainly depends on the physician preference. This study aims to describe the prevalence of vasopressor use and the trend in the use of each vasopressor medication in CICU over the past 7 yr.

Methods: This is a descriptive study conducted at a tertiary referral hospital. All cardiac ICU admissions at our institution between January 2007 and December 2013 were included in this study. The use of vasopressor within given CICU day (12.00 am – 11.59 pm) during CICU stay was reviewed. Vasopressors were defined as the continuous intravenous administration of norepinephrine, epinephrine, dopamine, phenylephrine, or vasopressin regardless of duration and dosage. The use of each vasopressor was reported as the vasopressor utilization index (VUI), using the following formula Vasopressor utilization index (VUI) = (The total number of ICU days on a given vasopressor)/(The total number of ICU days on any vasopresor).

Results: Out of 5,659 ICU days with vasopressor use, dopamine was used for 4,320 (76%), norepinephrine for 958 (17%), vasopressin for 661 (12%), epinephrine for 534 (9%), and phenylephrine for 471 (8%). From 2007 through 2013, there was a slight decreasing trend in the use of epinephrine (VUIepinephrine was 0.13 in 2007 and 0.06 in 2013), phenylephrine (VUIphenylephrine was 0.14 in 2008 and 0.05 in 2013), and vasopressin (VUIvasopressin was 0.19 in 2007 and 0.08 in 2013). Norepinephrine and dopamine trends did not change In the cardiac care unit, use of low-dose dopamine is still common (VUIlow-dose dopamine was 0.46) without any decreasing trend in its utilization.

Conclusions: Dopamine was the most commonly used vasopressor from 2007 through 2013 in cardiac ICU. Despite several recent trials and guidelines showing the adverse effects of dopamine use, it is still used frequently in the cardiac care unit.