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Realistic Survival Outcomes After Vasopressor Use in the Intensive Care Unit
American Journal of Hospice & Palliative Medicine® 1-4 ª The Author(s) 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049909115593065 ajhpm.sagepub.com
Daniel T. Farkas, MD1, Amir A. Rahnemai-Azar, MD1, Shameem Shah Kunhammed, MD1, Arieh Greenbaum, MD1, Shahida Bibi, MD1, and Mohan Mathew John, MD1
Abstract Aim: Patients in the intensive care unit (ICU) have significantly increased mortality rates. Frequently, clinicians are called upon to help families make decisions regarding aggressiveness of care. Having a realistic expectation of outcome is critical for these discussions. This article looked at survival and outcomes following initiation of vasopressors. Methods: All patients admitted to the ICU between January and June 2011were included. Patients were classified into those who had been started on vasopressors (VPþ) and those who had not (VP). Outcomes of these groups including survival were calculated and compared. Results: A total of 1023 patients were included: 169 in the VPþ group and 854 in the VP group. The survival rate in the VPþ group was 29.6% compared to 92.0% in the VP group. This was both clinically and statistically significant (P < .001). Conclusion: Patients started on vasopressors in the ICU have very poor outcomes. Being able to quantify this accurately is important to clinicians having discussions with family members. Keywords survival, outcomes, vasopressors
Introduction Patients admitted to the intensive care unit (ICU) are the most critically ill patients in the hospital and have increased morbidity and mortality.1 Clinicians are often called upon to discuss the prognosis and to help families with difficult treatment decisions. For example, patients in the ICU often develop indications for surgery, and managing realistic expectations is essential.2 Being able to provide accurate prognostic information to families is extremely helpful in end-of-life decision making.3,4 As a result, much research has gone into developing models for predicting patient outcomes, including various scoring systems based on physiologic status.5-7 These have all been validated to show differences between patients on admission to the ICU and are helpful both in predicting outcomes and in classification for research purposes. Other studies have looked at the subject more simply, evaluating the outcomes after a single event. For example, there has been extensive research looking at survival and outcomes following cardiopulmonary resuscitation (CPR) while in the hospital.8,9 The purpose of these articles was not to suggest that CPR is the cause of the worse outcomes, since it is clear that whatever led to the cardiac arrest is responsible for that. Nor is it to simply demonstrate that patients who undergo CPR have worse outcomes— as this is intuitive and self-evident. Rather, the aim of these studies was to accurately quantify the outcomes after CPR.
Knowing that less than 1 in 5 patients after CPR will survive to hospital discharge is a helpful information in discussions with family considering a do-not-resuscitate (DNR) order. One event that frequently takes place in the ICU setting is the initiation of vasopressors to control hemodynamic instability.10 Not surprisingly, this is associated with a significant increase in mortality.11 The purpose of this study was to look at such patients and accurately quantify the outcomes. Could we provide useful prognostic information to clinicians and families who are asked to make decision about patients on vasopressors?
Methods This was a retrospective study of consecutive patients admitted to the adult ICU between January 2011 and June 2011. This took place in a 960-bed community hospital with 26 critical care beds. The majority of the patients were on the medical service, with only occasional surgical patients when the surgical 1
Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY, USA
Corresponding Author: Daniel T. Farkas, MD, Bronx-Lebanon Hospital Center, 1650 Selwyn Ave, Suite 4E, New York City, NY 10457, USA. Email: [email protected]
Downloaded from ajh.sagepub.com by guest on November 14, 2015
American Journal of Hospice & Palliative Medicine®
2 Table 1. Comparison Between the 2 Groups.
Demographics Age (mean + SD) Male Outcomes Survived
Vasopressors (VPþ), n ¼ 169
No vasopressors (VP), n ¼ 854
P value
61.52 + 15.28 85 (50.3%)
55.32 + 16.64 409 (47.9%)
Realistic Survival Outcomes After Vasopressor Use in the Intensive Care Unit
American Journal of Hospice & Palliative Medicine® 1-4 ª The Author(s) 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049909115593065 ajhpm.sagepub.com
Daniel T. Farkas, MD1, Amir A. Rahnemai-Azar, MD1, Shameem Shah Kunhammed, MD1, Arieh Greenbaum, MD1, Shahida Bibi, MD1, and Mohan Mathew John, MD1
Abstract Aim: Patients in the intensive care unit (ICU) have significantly increased mortality rates. Frequently, clinicians are called upon to help families make decisions regarding aggressiveness of care. Having a realistic expectation of outcome is critical for these discussions. This article looked at survival and outcomes following initiation of vasopressors. Methods: All patients admitted to the ICU between January and June 2011were included. Patients were classified into those who had been started on vasopressors (VPþ) and those who had not (VP). Outcomes of these groups including survival were calculated and compared. Results: A total of 1023 patients were included: 169 in the VPþ group and 854 in the VP group. The survival rate in the VPþ group was 29.6% compared to 92.0% in the VP group. This was both clinically and statistically significant (P < .001). Conclusion: Patients started on vasopressors in the ICU have very poor outcomes. Being able to quantify this accurately is important to clinicians having discussions with family members. Keywords survival, outcomes, vasopressors
Introduction Patients admitted to the intensive care unit (ICU) are the most critically ill patients in the hospital and have increased morbidity and mortality.1 Clinicians are often called upon to discuss the prognosis and to help families with difficult treatment decisions. For example, patients in the ICU often develop indications for surgery, and managing realistic expectations is essential.2 Being able to provide accurate prognostic information to families is extremely helpful in end-of-life decision making.3,4 As a result, much research has gone into developing models for predicting patient outcomes, including various scoring systems based on physiologic status.5-7 These have all been validated to show differences between patients on admission to the ICU and are helpful both in predicting outcomes and in classification for research purposes. Other studies have looked at the subject more simply, evaluating the outcomes after a single event. For example, there has been extensive research looking at survival and outcomes following cardiopulmonary resuscitation (CPR) while in the hospital.8,9 The purpose of these articles was not to suggest that CPR is the cause of the worse outcomes, since it is clear that whatever led to the cardiac arrest is responsible for that. Nor is it to simply demonstrate that patients who undergo CPR have worse outcomes— as this is intuitive and self-evident. Rather, the aim of these studies was to accurately quantify the outcomes after CPR.
Knowing that less than 1 in 5 patients after CPR will survive to hospital discharge is a helpful information in discussions with family considering a do-not-resuscitate (DNR) order. One event that frequently takes place in the ICU setting is the initiation of vasopressors to control hemodynamic instability.10 Not surprisingly, this is associated with a significant increase in mortality.11 The purpose of this study was to look at such patients and accurately quantify the outcomes. Could we provide useful prognostic information to clinicians and families who are asked to make decision about patients on vasopressors?
Methods This was a retrospective study of consecutive patients admitted to the adult ICU between January 2011 and June 2011. This took place in a 960-bed community hospital with 26 critical care beds. The majority of the patients were on the medical service, with only occasional surgical patients when the surgical 1
Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY, USA
Corresponding Author: Daniel T. Farkas, MD, Bronx-Lebanon Hospital Center, 1650 Selwyn Ave, Suite 4E, New York City, NY 10457, USA. Email: [email protected]
Downloaded from ajh.sagepub.com by guest on November 14, 2015
American Journal of Hospice & Palliative Medicine®
2 Table 1. Comparison Between the 2 Groups.
Demographics Age (mean + SD) Male Outcomes Survived
Vasopressors (VPþ), n ¼ 169
No vasopressors (VP), n ¼ 854
P value
61.52 + 15.28 85 (50.3%)
55.32 + 16.64 409 (47.9%)
