PURPOSE: To review cases of septic shock treated outside the intensive care unit (ICU) setting with a fixed non-titratable continous infusion of vasopressin, determining its effects on survival, hemodynamics, and any adverse effects.
METHODS: With permission from our IRB, we conducted a retrospective review of all patients that received vasopressin infusion for septic shock, between the dates of January 1, 2003 and December 31, 2003. In a tertiary care academic medical center. Values were expressed as percentages and means (standard deviation).
RESULTS: Of 193 patients that received vasopressin infusion, 29 patients with septic shock were identified as having been treated outside the ICU. They had the following characteristics Age of 74.7 years (16.1), 45% male, 45% were intubated, APACHE II score 20.1 (7.2), and 52% of the cases had do not resuscitate orders in place. 19 (65%) of these patients had survived the hospitalization. All received a non-titrating infusion of 0.04 units/minute of vasopressin the average duration of which was 64.8 (54.8) hours. Systolic blood pressure had increased by 25.7% from 82.7 mmHg at onset to 101-mmHg post 48 hours infusion. Mean arterial pressure had increased by 21% from 60.9 to 78 mmHg. Serum Lactate decreased from 1.7 at onset to 0.84 at end of the infusion period, BUN from 43.9(33) to 27.8(21), and serum creatinine from 1.7 (1.6) to 1.3 (1.5). 10.3% patients died during the infusion. Bradyarrythmias and tissue necrosis were not observed in any of the cases.
CONCLUSION: For patients with septic shock who do not meet admission criteria to the ICU, therapy for with a non-titrating dose of vasopressin may be an additional therapy utilized on the regular hospital ward.
CLINICAL IMPLICATIONS: Vasopressin at a fixed dose of 0.04 units for use in patients with septic shock who do not otherwise meet criteria for admission into the ICU may have significant implications on the utilization of resources such as cardiac and hemodynamic monitoring, as well as nursing resources.
DISCLOSURE: Kaye Hale, None.
Manoj L. Karwa MBBS Kaye Hale MD * Montefiore, Bronx, NY
COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group