UT SON Dissertations (Open Access)

Date of Award

Fall 12-2019

Degree Name

Doctor of Philosophy in Nursing (PhD)

Advisor(s)

Sandra K. Hanneman, PhD

Second Advisor

Joanne V. Hickey, PhD

Third Advisor

Joseph L. Nates, M.D.

Abstract

Background: Vasopressor therapy in patients with septic shock can lead to harmful effects.

Objective: To describe vasopressor titration in patients with septic shock.

Methods: Single-center descriptive study of 60 intensive care unit (ICU) patients to calculate rates for events of failure to titrate, incorrect titration, and correct titration in 15- minute intervals for the duration of vasopressor therapy. Total hospital and ICU days, mortality rate, vasopressor dose and time, and the impact of hydrocortisone on vasopressor use were examined.

Results: During the total vasopressor infusion time of 2598 hours, 5395 failure-to-titrate events were noted. There were 316 incorrect titrations and 704 correct titrations. Converting the aggregate titration opportunities to an hourly rate, and based on documentation of mean arterial blood pressure at 15-minute intervals, the failure-to-titrate hourly rate was 50%, the incorrect- titration rate was 2%, and the correct-titration hourly rate was 48% (titration not indicated and correct titration). Patients with higher acuity score were more likely to receive corticosteroids than those with lower acuity score. When controlling for acuity of illness with APACHE II or SOFA scores, Cox regression showed no meaningful difference (p =.18 for APACHE II and p = .31 for SOFA) time on vasopressors between patients receiving and those not receiving corticosteroids.

Conclusions: Failure to titrate vasopressor events are high in ICU patients with septic shock.

Keywords

vasopressor titration, intensive care, septic shock

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Nursing Commons

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