Monday April 21, 2008
Regarding Early Use of Vasopressors

There has been growing evidence that overly aggressive crystalloid resuscitation is associated with iatrogenic complications, thus had renewed the interest of using vasopressors for early hemodynamic support.

Jason Sperry used the multi-center data to evaluate the outcome of blunt injured adults in hemorrhagic shock. Of the 1036 patients in the entire trauma cohort, 921 survived beyond 48 hours. Cox proportional hazard regression revealed the early vasopressor use within 12 hours after injury was independently associated with an over 80% higher risk of mortality (hazard ratio [HR] 1.8, 95% CI 1.1-2.9), and was independently associated with over a two fold higher risk of mortality at 24 hours (p=0.001). These findings were seen consistent with all vasopressor subtype. In contrast aggressive crystalloid resuscitation was associated with 40% decrease in mortality.

Conclusion: Caution before constriction.

Findings provide evidence that the early use of vasopressors for hemodynamic support after hemorrhagic shock may be deleterious, and should be used cautiously and not in place of aggressive crystalloid resuscitation after severe blunt injury.



Reference: click to get abstract

Sperry JL, Minei JP, Frankel HL, West MA, Moore EE, Maier RV, Nirula R., Early Use of Vasopressors After Injury: Caution Before Constriction, Journal of Trauma-Injury Infection & Critical Care. 64(1):9-14, January 2008.