(1039) Impact of Vasopressin Guidelines in the Surgical Intensive Care Unit

Introduction: Hospital-wide perioperative practice involves titrating vasopressin (VASO) to meet blood pressure goals in patients with vasodilatory shock. In August 2023, a new guideline using VASO as a flat dose starting at 2.4 units/h was implemented in the Surgical Intensive Care Unit (SICU). The objective of this study was to determine how the management of VASO changed with guideline implementation.

Methods: An IRB-approved, retrospective chart review was conducted including adult patients discharged between September 2022 and December 2022 (pre-guideline [PRE)]) and September 2023 and December 2023 (post-guideline [POST]). All patients evaluated received VASO while in the SICU. Patients admitted to the SICU from another ICU or transferred out of the SICU to another ICU while on vasopressors were excluded. Data is presented as median (interquartile range [IQR]). Wilcoxon Rank Sum test was used for two group comparisons. A p< 0.05 was considered significant.

Results: A total of 56 patients were included in the PRE group and 74 patients in the POST group. Higher initial VASO doses were used in the POST compared to the PRE group [2 (2, 2.4) vs 2.4 (2.4, 2.4) units/h, p< 0.001], but there was no difference in the highest dose of VASO used [4 (2, 6) vs 2.4 (2.4, 4) units/h, p=0.48]. There was no difference in the frequency of VASO initiation in patients receiving less than 10 mcg/min of norepinephrine (NE) (PRE 48% vs POST 36%, p=0.42). There was no difference between the PRE and POST groups in the duration of VASO [1212 (286, 2401) vs 821 (368, 1761) min, p=0.44], total dose of VASO [38 (7, 122) vs 39 (14, 78) units, p=0.81], and dose of NE at which VASO was discontinued [3 (2, 4) vs 4 (2, 6) mcg/min, p=0.55] in patients who survived to discharge. Titratable VASO orders decreased from 100% to 19% after guideline implementation (p < 0.001). The total number of VASO bags dispensed [3 (1, 4) vs 2 (1, 4) bags, p=0.23] and cost of VASO [$373 (124, 497) vs $249 (124, 497), p=0.23] per patient did not change with guideline implementation.

Conclusions: More VASO orders were written as flat doses rather than as titratable infusions after guideline implementation, but there was no difference in the duration and total amount of VASO used. The doses of NE at which VASO was initiated and discontinued did not change.