Abstract:
Background: Inotropes and vasopressors are administered to offer hemodynamic
support to patients in shock, as a temporary measure to allow for correction of the
underlying disease. Inotropes increase cardiac output while vasopressors increase total
peripheral resistance leading to a rise in mean arterial pressure (MAP) and perfusion.
Despite the high mortality observed among patients started on vasoactive drugs, there
is limited data on their use and outcomes in low-income setting and influence of
comorbidities. This study aims to document the outcomes of patients started on
vasoactive drugs.
Objectives: To describe the clinical outcomes of patients started on inotropes and/or
vasopressors at MTRH, Eldoret.
Methods: This was a prospective observational hospital-based census study that
recruited patients who were admitted at the Coronary Care Unit (CCU) in MTRH
between December 2018 and June 2019 and received inotropes and/or vasopressors.
Data on age, gender, length of stay, medication history, laboratory findings and
diagnosis were collected. Patients were followed until discharge from CCU and data
on outcomes collected. Sociodemographic and clinical characteristics were analyzed
using descriptive statistics. Fischer‘s exact test was used to determine association
between outcomes and the various agents and their combinations used. Multinomial
regression was used to determine effect of mean arterial pressure on outcomes. p <
0.05 was considered significant
Results: 68 patients with a mean age of 51.1 (SD 23.9) years were recruited. Most
were female patients (57.3%), who had been admitted in cardiogenic shock (75.7%)
due to acute decompensated heart failure (72.5%), with rheumatic heart disease as the
main comorbidity (18.2%). Mean baseline MAP was 61.8 mmHg while systolic and
diastolic blood pressure was 82 mmHg and 52 mmHg respectively. Most patients
(52.9%) received dobutamine as the first agent. A second agent, norepinephrine,
dobutamine or milrinone, was administered to 28 (41.2%) patients who had not
initially responded adequately. Characteristics of participants who received various
agents were similar. The mean arterial pressure in patients treated with one inotrope
was significantly higher than in patients who were treated with at least two inotropes
(p < 0.001). Thirty-seven (54.4 %) patients died, 9(13.2 %) were discharged to the
wards and 22(32.4 %) were discharged home. There was no significant association
between outcomes and the initial agent administered (p= 0.807) or the various
combinations (p=0.334). Patients with an elevated mean arterial pressure after
inotrope treatment were more likely to be discharged to the wards (OR 1.3 [95% CI
1.1-1.6, p=0.001]) or discharged home (OR 1.2 [95% CI 1.1-1. 3, p=0.002]) than to
die.
Conclusion: Patients with higher MAPs after inotrope/vasopressor administration had
better clinical outcomes compared to those with lower MAPs. There was no
significant association between the type of inotrope/vasopressor and outcomes.
Additionally, there was no significant difference between the use of either one or two
inotropes/vasopressors.
Recommendations: Further studies with bigger sample sizes need to be conducted to
further explore the findings of this study.