CHANGING TRENDS IN THE USE OF VASOPRESSORS IN INTENSIVE CARE UNIT: A 7-YEAR STUDY

Learning Objectives: The use of vasopressors was common in intensive care unit (ICU). 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 ICU over the past 7 years.

Methods: This is a descriptive study conducted at a tertiary referral hospital. All ICU admissions, including both medical and surgical ICU, at our institution between January 2007 and December 2013 were included in this study. The use of vasopressors within given ICU day (12.00 am – 11.59 pm) during ICU stay was reviewed. Vasopressors were defined as the continuous intravenous administration of norepinephrine, epinephrine, dopamine, phenylephrine, or vasopressin regardless of duration and dosage.

Results: A total of 52410 unique patients had 72005 ICU admissions in the course of study, (272271 patientICU day). Vasopressors were used in 17767 (24.7%) ICU admissions and on 53898 (19.8%) patientICU day, resulting in a total of 76564 vasopressor day. Vasopressin was used on 21955 (41%), epinephrine on 20958 (39%), norepinephrine on 17919 (33%), dopamine on 8636 (16%) and phenylephrine on 7096 (13%) patient*ICU day. Over 2007-2013, there was an upward trend in the use of norepinephrine (the proportion of ICU day on norepinephrine over total ICU day with vasopressor 0.24 in year 2007 to 0.45 in year 2013), and a downward trend in phenylephrine (the proportion of ICU day on phenylephrine over total ICU day with vasopressor 0.20 in year 2007 to 0.10 in year 2013). There was no specific trend in the usage of vasopressin, epinephrine, and dopamine.

Conclusions: The vasopressors were used in about one fourth of ICU admission and about one fifth of ICU days. Vasopressin is the most commonly used vasopressor. The use of norepinephrine is in upward trajectory.