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Title: Incidence, Patient Characteristics, Mode of Drug Delivery, and Outcomes of Septic Shock Patients Treated with Vasopressors in the Arise Trial.
Austin Authors: Udy, Andrew A;Finnis, Mark;Jones, Daryl A ;Delaney, Anthony;Macdonald, Stephen;Bellomo, Rinaldo ;Peake, Sandra
Affiliation: Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
Intensive Care Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia
Northern Clinical School, Sydney Medical School, University of Sydney, St Leonards, New South Wales, Australia
Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
Department of Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
Issue Date: Oct-2019 2018-10-30
Publication information: Shock (Augusta, Ga.) 2019; 52(4): 400-407
Abstract: To describe the utilization of vasopressors (VP) in patients enrolled in the Australasian Resuscitation In Sepsis Evaluation (ARISE) trial, and to explore the association between time to VP and 90-day mortality. The primary exposure variable was VP use after arrival in the emergency department (ED). Vasoactive agents considered as VP included: norepinephrine, epinephrine, metaraminol, or vasopressin. Time-to-event analysis, multivariable logistic regression, and propensity-matched treatment effects modeling were used to assess the association between time to VP and 90-day mortality. In total 1,102 of 1,588 patients (69%) in ARISE received VP at any point. The median [interquartile range (IQR)] time from ED presentation to commencing VP was 4.4 [2.7, 7.1] h, and 38% did so prior to central venous access. The median [IQR] volume of intravenous (i.v.) fluid administered prior to commencing VP was 3.1 [2.3, 4.3] L. Increasing age and volume of i.v. fluid therapy were associated with a lower likelihood of commencing VP early (within 4 h of ED presentation), while greater illness severity was associated with a higher likelihood, P < 0.001, respectively. In those who subsequently died within 90 days, the sub-hazard ratio (95% confidence interval) for commencing VP was 1.4 (1.20, 1.68), P < 0.001, adjusted for age, acute physiology and chronic health evaluation II score, study group, inclusion criteria, plasma lactate, i.v. fluid prior to VP, study institution, and site of infection. 50% of the ARISE cohort commenced VP within 4.4 h of ED presentation, and many did so prior to central venous access. Earlier initiation of VP was associated with greater crude and adjusted 90-day mortality.
DOI: 10.1097/SHK.0000000000001281
ORCID: 0000-0002-1650-8939
PubMed URL: 30379749
Type: Journal Article
Appears in Collections:Journal articles

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