Prys-Picard Curig O, Shah Shiwan K, Williams Brandie D, Cardenas Victor, Sharma Gulshan
Division of Pulmonary and Critical Care Medicine, University of Texas Medical Branch, TX, USA.
J Intensive Care Med. 2013 Jul-Aug;28(4):237-40. doi: 10.1177/0885066612448738. Epub 2012 Jun 24.
Vasoactive drugs are routinely used in critically ill patients with shock to optimize the hemodynamic state while evaluating and treating potentially reversible causes. Limited data exist on the use of multiple vasoactive drugs in the intensive care unit. We hypothesize that the use of 3 or more vasoactive drugs is associated with worse outcomes.
We retrospectively examined the outcome in patients, at least 18 years of age, in whom 3 or more vasoactive drugs were administered simultaneously. We included patients admitted between November 2007 and August 2009. Vasoactive drugs included dopamine, dobutamine, epinephrine, norepinephrine, phenylephrine, and vasopressin. The primary end point was survival to hospital discharge.
Sixty-six patients received 3 or more vasoactive drugs simultaneously. Nine patients (14%) survived to ICU discharge and 6 patients (9%) survived to hospital discharge. There was a significant difference in mean Simplified Acute Physiology Score II between survivors (32.3 ± 28.6) and nonsurvivors (72.1 ± 30.4), P = .003. Five of the 6 survivors had an acute cardiac procedure, either percutaneous cardiac intervention or heart transplantation. The 1 patient with septic shock who survived had surgery for a bowel perforation. All patients who survived received inotropic therapy (dobutamine). None of the patients who received 4 or more vasoactive drugs survived.
Patients requiring 3 or more vasoactive drugs rarely survive in the absence of an intervention aimed at correcting the underlying cause such as revascularization or source control surgery.
血管活性药物常用于治疗重症休克患者，以优化血流动力学状态，同时评估并治疗潜在的可逆病因。关于重症监护病房中使用多种血管活性药物的数据有限。我们假设使用3种或更多血管活性药物与更差的预后相关。
我们回顾性研究了至少18岁、同时使用3种或更多血管活性药物的患者的预后情况。纳入2007年11月至2009年8月期间入院的患者。血管活性药物包括多巴胺、多巴酚丁胺、肾上腺素、去甲肾上腺素、去氧肾上腺素和血管加压素。主要终点是存活至出院。
66例患者同时接受了3种或更多血管活性药物治疗。9例患者（14%）存活至重症监护病房出院，6例患者（9%）存活至医院出院。存活者（32.3±28.6）和非存活者（72.1±30.4）的平均简化急性生理学评分II存在显著差异，P = 0.003。6例存活者中有5例接受了急性心脏手术，即经皮心脏介入治疗或心脏移植。1例存活的感染性休克患者接受了肠穿孔手术。所有存活患者均接受了正性肌力治疗（多巴酚丁胺）。接受4种或更多血管活性药物治疗的患者无一存活。
在没有针对纠正潜在病因（如血运重建或源头控制手术）的干预措施的情况下，需要3种或更多血管活性药物治疗的患者很少存活。
