(1268) Clinical Impact of Concentrated Vasopressors and Inotropes in the Intensive Care Unit

Introduction: Standard concentrations of vasopressor and inotrope infusions can contribute to significant fluid intake. These drips are often switched to double concentrated formulations to minimize fluid volume. Prior to this medication use evaluation at our academic medical center, there was no standardized method for ordering these concentrated drips or communicating these changes to nurses. The objective of this medication use evaluation was to assess the clinical impact of these concentrated drips.

Methods: A retrospective analysis of 50 randomly selected patients on concentrated norepinephrine, epinephrine, dopamine, dobutamine, or milrinone for at least 24 hours between January 2022 and August 2023 was conducted using the health system's electronic medical record (EMR). The primary and secondary outcomes included the total fluid intake and net balance, the diuretic doses, and ability to discontinue continuous renal replacement therapy (CRRT).

Results: Concentrated drips were used in 3.1% of study patients. Patients who switched to a concentrated drip had a decrease of 40 mL/hour (960 mL/day) intake on average compared to standard concentration. Use of concentrated drips allowed for a negative fluid balance and reduced the daily fluid intake attributable to the drip from an average of 14% to 10%. However, no benefit was demonstrated in diuretic utilization. Although 77% of patients were on CRRT at the time of the concentration change, 14% were able to discontinue CRRT while on a concentrated drip.

Conclusions: Concentrated drips are used in a small proportion of ICU patients to decrease an average 40 mL/hour (960 mL/day) intake from standard concentration. Use of concentrated drips allowed for negative fluid balance and helped discontinue CRRT in some patients, although no benefit was demonstrated in diuretic utilization. This data suggests that patients who may benefit from double concentrating vasopressors are those receiving at least 1 L of volume per day from standard concentration drips, and that we may be able to prevent or discontinue CRRT by using concentrated formulations.