Intensive Care Medicine

, Volume 38, Issue 6, pp 950–958

Adverse cardiac events during catecholamine vasopressor therapy: a prospective observational study

  • Christian A. Schmittinger
  • Christian Torgersen
  • Günter Luckner
  • Daniel C. H. Schröder
  • Ingo Lorenz
  • Martin W. Dünser
Original

DOI: 10.1007/s00134-012-2531-2

Cite this article as:
Schmittinger, C.A., Torgersen, C., Luckner, G. et al. Intensive Care Med (2012) 38: 950. doi:10.1007/s00134-012-2531-2

Abstract

Purpose

To determine the incidence of and risk factors for adverse cardiac events during catecholamine vasopressor therapy in surgical intensive care unit patients with cardiovascular failure.

Methods

The occurrence of any of seven predefined adverse cardiac events (prolonged elevated heart rate, tachyarrhythmia, myocardial cell damage, acute cardiac arrest or death, pulmonary hypertension-induced right heart dysfunction, reduction of systemic blood flow) was prospectively recorded during catecholamine vasopressor therapy lasting at least 12 h.

Results

Fifty-four of 112 study patients developed a total of 114 adverse cardiac events, an incidence of 48.2 % (95 % CI, 38.8–57.6 %). New-onset tachyarrhythmia (49.1 %), prolonged elevated heart rate (23.7 %), and myocardial cell damage (17.5 %) occurred most frequently. Aside from chronic liver diseases, factors independently associated with the occurrence of adverse cardiac events included need for renal replacement therapy, disease severity (assessed by the Simplified Acute Physiology Score II), number of catecholamine vasopressors (OR, 1.73; 95 % CI, 1.08–2.77; p = 0.02) and duration of catecholamine vasopressor therapy (OR, 1.01; 95 % CI, 1–1.01; p = 0.002). Patients developing adverse cardiac events were on catecholamine vasopressors (p < 0.001) and mechanical ventilation (p < 0.001) for longer and had longer intensive care unit stays (p < 0.001) and greater mortality (25.9 vs. 1.7 %; p < 0.001) than patients who did not.

Conclusions

Adverse cardiac events occurred in 48.2 % of surgical intensive care unit patients with cardiovascular failure and were related to morbidity and mortality. The extent and duration of catecholamine vasopressor therapy were independently associated with and may contribute to the pathogenesis of adverse cardiac events.

Keywords

Catecholamines Vasopressor Adverse cardiac event Tachyarrhythmia Prolonged elevated heart rate Myocardial ischemia 

Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • Christian A. Schmittinger
    • 1
    • 2
  • Christian Torgersen
    • 1
    • 3
  • Günter Luckner
    • 3
  • Daniel C. H. Schröder
    • 3
  • Ingo Lorenz
    • 3
  • Martin W. Dünser
    • 4
  1. 1.Department of Intensive Care MedicineInselspital, Bern University Hospital, University of BernBernSwitzerland
  2. 2.Department of Anaesthesiology, Surgical Intensive Care Medicine, and Rescue MedicineLucerne Cantonal HospitalLucerneSwitzerland
  3. 3.Department of Anaesthesiology and Critical Care MedicineInnsbruck Medical UniversityInnsbruckAustria
  4. 4.Department of Anaesthesiology, Perioperative and Intensive Care Medicine, Salzburg General HospitalParacelsus Private Medical UniversitySalzburgAustria

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