Nicholas Nelson, BCPS, PharmD
University of Michigan Health System
Ann Arbor, MI
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Title: Impact of Catecholamine Use on Pulmonary Artery Pressures in Patients with Pulmonary Hypertension
Introduction: Pulmonary hypertension (PH) has been associated with high morbidity and mortality and its management poses many challenges in the intensive care unit (ICU) setting. Appropriate optimization of volume status, cardiac output and systemic perfusion are critical in these patients. Vasopressors are required for cases of systemic hypotension, however, little data investigating their impact on pulmonary vasculature in critically ill adults currently exist. This study sought to assess the effect of catecholamine (CA) administration of pulmonary artery pressure (PAP) in patients with PH.
Methods: A retrospective cohort study of patients with PH admitted to a cardiac or cardiothoracic surgery ICU between December 2019 and June 2021 that had a pulmonary artery catheter placed and received either epinephrine or norepinephrine was conducted. Patients were excluded if they received a lung transplant, had missing PAPs, or if other vasopressors were changed between CA discontinuation and PAP measurements. PAP readings before and after CA discontinuation were collected to assess impact of CA on PAP. Pre and post systolic, diastolic, and mean PAP were compared using Wilcoxon Signed Rank Test.
Results: Of 57 identified patients, 28 were included. Patients were a median 60.8 years old and weighed 90.6kg. The majority of patients (74%) were male. Median final NE equivalent dose prior to discontinued of CA was 0.02 [0.01-0.04] mcg/kg/min. No significant difference was found between pre and post systolic, diastolic, or mean PAP (37.5 [28.8-50.5] vs 38.5 [29-52] mmHg, 18.5 [13-22.5] vs 18 [14.5-22.3] mmHg, 25.7 [17.4-30.7] vs 24 [19.5-32] mmHg, respectively). Overall, 50% of patient's mean PAP decreased while 42.9% increased following cessation of CA therapy.
Conclusions: Low dose CA administration has little effect on PAP. Use of norepinephrine or epinephrine as a vasopressor in patients with PH may be appropriate. Future studies are necessary to replicate these findings and determine the impact of higher doses of CA on PAP as this remains unclear.