Association of premorbid blood pressure with vasopressor infusion duration in patients with shock

Hayley B. Gershengorn, Henry T. Stelfox, Daniel J. Niven, Hannah Wunsch

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Rationale: Guidelines for vasopressor titration suggest a universal target mean arterial pressure (MAP).65mmHg. The implications for patients with premorbid low/high blood pressure are unknown. Objectives: To investigate the relationship between premorbid blood pressure and vasopressor duration for patients with shock. Methods: We performed a retrospective cohort study of adults admitted with shock to Calgary ICUs (June 2012-December 2018). The primary exposure was premorbid blood pressure: low (systolic ,100); normal (systolic 100-139 and diastolic ,90); and high (systolic 140 or diastolic 90). The primary outcome was vasopressor duration; secondary outcomes included ICU/hospital length of stay and ICU/hospital mortality.We examined associations of premorbid blood pressure with vasopressor duration and length of stay using multivariable competing risk models and mortality using multivariable mixed-effects logistic regression. Measurements and Main Results: Of 3,542 admissions with shock, 177 (5.0%) had premorbid low, 2,887 (81.5%) normal, and 478 (13.5%) high blood pressure. Premorbid low admissions had lower MAPs (vs. normal or high premorbid admissions) over the duration of vasopressor use (P = 0.003) and were maintained nearest premorbid MAPs while receiving vasopressors (P,0.001). After adjustment, premorbid low admissions had longer vasopressor use (median, 1.35 d vs. 1.04 d for normal; hazard ratio for discontinuation vs. normal, 0.78 [0.73-0.85]; P,0.001) and premorbid high admissions had shorter use (median, 0.84 d; hazard ratio, 1.22 [1.12-1.33]; P,0.001). Premorbid low admissions had longer adjusted length of stay and higher adjusted mortality than premorbid normal admissions. Conclusions: Premorbid blood pressure was inversely associated with vasopressor duration.

Original languageEnglish (US)
Pages (from-to)91-99
Number of pages9
JournalAmerican journal of respiratory and critical care medicine
Volume202
Issue number1
DOIs
StatePublished - Jul 1 2020

Keywords

  • Blood Pressure
  • Goals
  • ICU
  • Shock

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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