The use of Vasoactive-Inotropic Score in Adult Patients with Septic Shock in Intensive Care

Vasoactive and inotropic medications are essential for sepsis management; however, the association between the maximum Vasoactive-Inotropic score (VISmax) and clinical outcomes is unknown in adult patients with sepsis. We investigated the VISmax as a predictor for mortality among such patients in the emergency department (ED) and compared its prognostic value with that of the sequential organ failure assessment (SOFA) score. This single-center retrospective study included 910 patients diagnosed with sepsis between January 2016 and March 2020. We calculated the VISmax using the highest doses of vasopressors and inotropes administered during the first 6 h on ED admission and categorized it as 0–5, 6–15, 16–30, 31–45, and >45 points. The primary outcome was 30-day mortality. VISmax for 30-day mortality was significantly higher in non-survivors than in survivors. The mortality rates in the five VISmax groups were 17.2%, 20.8%, 33.3%, 54.6%, and 70.0%, respectively. The optimal cut-off value of VISmax to predict 30-day mortality was 31. VISmax had better prognostic value than the cardiovascular component of the SOFA score and initial lactate levels. VISmax was comparable to the APACHE II score in predicting 30-day mortality. Multivariable analysis showed that VISmax 16–30, 31–45, and >45 were independent risk factors for 30-day mortality. VISmax in ED could help clinicians to identify sepsis patients with poor prognosis.

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VASOACTIVE INOTROPIC SCORE AS A PREDICTOR OF MORTALITY IN ADULT PATIENTS WITH CARDIOGENIC SHOCK

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)31355-x ◽

2018 ◽

Vol 71 (11) ◽

pp. A814

Author(s):

Soo Jin Na ◽

Chi Ryang Chung ◽

Yang Hyun Cho ◽

Kyeongman Jeon ◽

Gee Young Suh ◽

...

Keyword(s):

Cardiogenic Shock ◽

Adult Patients ◽

Inotropic Score ◽

Vasoactive Inotropic Score

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Role of Steroid in Adult Patients of Septic Shock - A Critical Analysis

KYAMC Journal ◽

10.3329/kyamcj.v4i2.32281 ◽

2017 ◽

Vol 4 (2) ◽

pp. 409-414

Author(s):

Rajib Hasan ◽

Humayun Kabir ◽

Taposh Chandra Roy ◽

Javed Sharoar Chowdhury ◽

Farzana Yeasmin

Keyword(s):

Septic Shock ◽

Intensive Care ◽

Intensive Care Units ◽

Critical Analysis ◽

Adult Patients ◽

Evidence Based ◽

Icu Patients ◽

Evidence Based Practices ◽

Sepsis And Septic Shock

" Sepsis and septic shock is the condition which has been with intensive care units from long before. In fact, it is one of the highly ranked diseases causing mortality in ICU patients. There are currently many evidence based practices in the management of septic shock and use of steroid is one of them. The aim of this article is to critically evaluate the evidences regarding the role of steroids in adult patients of septic shock. This article has also evaluated all the current evidences regarding details of the role of steroids including their formulation, dosage, duration and route of administration in patients of septic shock.KYAMC Journal Vol. 4, No.-2, Jan 2014, Page 409-414

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Vascular Reactivity Index as an Effective Predictor of Mortality in Children With Refractory Septic Shock

Journal of Intensive Care Medicine ◽

10.1177/0885066620914850 ◽

2020 ◽

pp. 088506662091485 ◽

Cited By ~ 2

Author(s):

En-Pei Lee ◽

Lu-Lu Zhao ◽

Shao-Hsuan Hsia ◽

Oi-Wa Chan ◽

Chia-Ying Lin ◽

...

Keyword(s):

Septic Shock ◽

Vascular Reactivity ◽

Characteristic Curve ◽

Pediatric Intensive Care ◽

Reactivity Index ◽

Survival Group ◽

Risk Of Mortality ◽

Inotropic Score ◽

Refractory Septic Shock ◽

Vasoactive Inotropic Score

Background: Vasoplegia is vascular hyporesponsiveness to vasopressors and is an important phenomenon in children with refractory septic shock. This study aimed to develop an objective formula correlated with vasoplegia and evaluate the predictive power for mortality in children with refractory septic shock. Materials and Methods: We retrospectively analyzed children with refractory septic shock admitted to a pediatric intensive care unit (PICU) and monitored their hemodynamics via a pulse index continuous cardiac output (PiCCO) system. Serial hemodynamic data including cardiac index (CI), systemic vascular resistant index (SVRI) and vasoactive-inotropic score (VIS) were recorded during the first 72 hours after PICU admission. We defined vascular reactivity index (VRI) as SVRI/VIS and analyzed the effect of VRI in predicting mortality in children with refractory septic shock. Results: Thirty-three children with refractory septic shock were enrolled. The SVRI was lower in the mortality group compared to the survival group ( P < .05). The average area under the receiver operating characteristic curve of VRI within the first 72 hours was 0.8 and the serial values of VRI were significantly lower in the mortality group during the period from 0 to 48 hours ( P < .05). However, there were no significant differences in serial CI values between the survival and mortality groups. Conclusions: Vasoactive-inotropic score may potentially be used to quantify the severity of vasoplegia based on the clinical response of vessels after resuscitation with vasopressors. Lower VRI levels may indicate a higher risk of mortality in children with septic shock.

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