Treatment with Vasoactive Drugs and Outcomes in Surgical Critically Ill Patients: The Results from the THAI-SICU Study
Thammasak Thawitsri MD*1, Kaweesak Chittawatanarat MD, PhD*2, Kanya Kumwilaisak MD*3, Somrat Charuluxananan MD*3, the THAI-SICU study group
Affiliation : *1 Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand *2 Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand *3 Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Objective : The purpose of this study is to assess the impact of the use of vasoactive drugs on morbidity and mortality in
surgical critically ill patients.
Material and Method: We conducted a multi-center prospective observational study in Thai university-based surgical
intensive care units (SICU) over a 22-month period. Patient data were recorded by case record form in 3 main phases:
admission, daily and discharge. Data collection included patient characteristics, pattern of vasoactive drugs use, and
outcomes.
Results : Nine university-based SICU comprising 4,652 patients were included in the study. The vasopressor exposed patient
group had 1,155 patients (24.8%). Either vasopressor or inotrope exposed group demonstrated significantly higher ICU
mortality, 28-day mortality and new arrhythmia than the non-exposed group (p<0.001). In multivariable analysis, norepinephrine
or epinephrine significantly increased risks of all unfavorable outcomes while dopamine significantly increased only new
arrhythmia (OR 1.44; 95% CI 1.02-2.02, p = 0.036) in vasopressor-exposed patients. Epinephrine had the highest risk of all
unfavorable outcomes with an OR 3.17; 95% CI 2.10-4.78, (p<0.001) for ICU mortality, OR 2.62; 95% CI 1.73-3.97,
(p<0.001) for 28-day mortality, and OR of 1.77; 95% CI 1.13-2.75, (p = 0.012) for new arrhythmia. Neither dobutamine nor
milrinone showed any significant results in inotrope exposed patients.
Conclusion : Vasoactive drug exposed patient groups had significantly higher incidence of new arrhythmia, ICU mortality,
and 28-day mortality. Epinephrine exposure was associated with the highest risk of unfavorable outcomes. Further information
from well-designed studies is needed to justify the most appropriate use of vasoactive drugs.
Keywords : Surgical ICU, Vasoactive drug, Vasopressor, Inotrope, ICU outcomes
