Early Vasopressor Use in Critical Injury Is Associated With Mortality Independent From Volume Status

• DOI: 10.1097/ta.0b013e3182213d52
• Publication Date: 2011-10-04T21:25:08Z
• Authors: David S. Plurad; Peep Talving; Lydia Lam; Kenji Inaba; Donald Green; Demetrios Demetri...
• Keywords: Hypovolemia

Background: Complications of excessive crystalloid after critical injury have increased interest in vasopressor support. However, it is hypothesized that use patients who are under-resuscitated associated with death. We performed this study to determine whether volume status mortality the critically injured exposed early vasopressors. Methods: The intensive care unit database at a Level I center was queried for all adult admissions surviving >24 hours from January 1, 2001, December 31, 2008. Patients spinal cord and severe traumatic brain were excluded. group [Vaso (+)] dopamine, epinephrine, phenylephrine, norepinephrine, or arginine vasopressin within 24 admission. Demographic data studied including admission central venous pressure. Hypovolemia [Hypov considered an pressure ≤8 mm Hg. Vaso (+) analyzed Hypov independently Results: Of 1,349 eligible patients, 26% (351) (+). Mortality 43.6% (153) versus 4.2% (42) (−) (17.60 [12.10–25.60], <0.01). Vasopressor exposure death independent severity. In not mortality, whereas Emergency Department Glasgow Coma Scale multiple were. Conclusions: regardless fluid status. Although advisable withhold support impending cardiovascular collapse, any during ongoing resuscitation should be approached extreme caution