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SUBOPTIMAL TACHYCARDIA ON ADMISSION OF SEPTIC PATIENTS ON BETA-BLOCKERS AND CALCIUM CHANNEL BLOCKERS AT HOME
October 2008, Vol 134, No. 4_MeetingAbstracts Abstract: Poster Presentations | October 2008
SUBOPTIMAL TACHYCARDIA ON ADMISSION OF SEPTIC PATIENTS ON BETA-BLOCKERS AND CALCIUM CHANNEL BLOCKERS AT HOME Omar Nehme, MD*; Walid Saad, MD; Sumit Bhutani, MD; Jean-Sebastien Rachoin, MD; Mazen Kreidy, MD; Christa Schorr, RN; David Gerber, DO Cooper University Hospital, Camden, NJ Chest Chest. 2008;134(4_MeetingAbstracts):p68004. doi:10.1378/chest.134.4_MeetingAbstracts.p68004
Abstract PURPOSE: Identifying different subsets of patients in septic shock might help adding newer therapies and improve mortality. Septic patients on BB and/or non-dihydropyridine nCCB at home are prevented from increasing their heart rate appropriately to maintain an acceptable blood pressure on admission, and might have worse outcome. METHODS: Retrospective analysis of patients presenting to Cooper University Hospital with septic shock from January 2004-August 2007. Demographics, cardiac history, type of BB and nCCB used at home, APACHE II score, vitals on admission and every 6 hours, hemodynamic support during the first 24 hours (number of vasopressors and inotropes), ICU and hospital length of stay (LOS) and mortality were recorded. This data was analyzed using Chi-square and Mann-Whitney U tests. RESULTS: 117 patients were identified. Patients on BB and/or nCCB (n=50) were older than the control group (n=67) (p=0.02), and more likely to have an underlying cardio-vascular history. They had lower heart rate in the initial 6 hours of resuscitation (p=0.02 at H0, p=0.01 at H6), but MAP was similar at all times in the first 24 hours. Patients on BB and/or nCCB required more hemodynamic support (usage of three concomitant pressors and at least one inotrope was more frequent compared to the control group, p=0.04 and 0.02 respectively), and had increased ICU and hospital LOS (p=0.03 and 0.04 respectively). Death was similar in both groups. When performing regression analysis, after adjusting for demographics, APACHE II score and cardiac history, use of nCCB was associated with administration of higher concomitant vasopressors (p=0.004) and at least one inotrope (p=0.043), use of BB was associated with higher ICU and hospital LOS (p=0.047, p=0.002 respectively) while APACHE II score was the only factor associated with death (p=0.011). CONCLUSION: Patients on BB and/or nCCB have a delayed recovery but similar mortality to those off these medications, despite an increase in age and prevalence of cardio-vascular disease.
CLINICAL IMPLICATIONS: Preadmission use of BB and nCCB may exert a long-term “protective” effect on septic patients admitted to the ICU. DISCLOSURE: Omar Nehme, No Financial Disclosure Information; No Product/Research Disclosure Information Tuesday, October 28, 2008 1:00 PM - 2:15 PM
SUBOPTIMAL TACHYCARDIA ON ADMISSION OF SEPTIC PATIENTS ON BETA-BLOCKERS AND CALCIUM CHANNEL BLOCKERS AT HOME Omar Nehme, MD*; Walid Saad, MD; Sumit Bhutani, MD; Jean-Sebastien Rachoin, MD; Mazen Kreidy, MD; Christa Schorr, RN; David Gerber, DO Cooper University Hospital, Camden, NJ Chest Chest. 2008;134(4_MeetingAbstracts):p68004. doi:10.1378/chest.134.4_MeetingAbstracts.p68004
Abstract PURPOSE: Identifying different subsets of patients in septic shock might help adding newer therapies and improve mortality. Septic patients on BB and/or non-dihydropyridine nCCB at home are prevented from increasing their heart rate appropriately to maintain an acceptable blood pressure on admission, and might have worse outcome. METHODS: Retrospective analysis of patients presenting to Cooper University Hospital with septic shock from January 2004-August 2007. Demographics, cardiac history, type of BB and nCCB used at home, APACHE II score, vitals on admission and every 6 hours, hemodynamic support during the first 24 hours (number of vasopressors and inotropes), ICU and hospital length of stay (LOS) and mortality were recorded. This data was analyzed using Chi-square and Mann-Whitney U tests. RESULTS: 117 patients were identified. Patients on BB and/or nCCB (n=50) were older than the control group (n=67) (p=0.02), and more likely to have an underlying cardio-vascular history. They had lower heart rate in the initial 6 hours of resuscitation (p=0.02 at H0, p=0.01 at H6), but MAP was similar at all times in the first 24 hours. Patients on BB and/or nCCB required more hemodynamic support (usage of three concomitant pressors and at least one inotrope was more frequent compared to the control group, p=0.04 and 0.02 respectively), and had increased ICU and hospital LOS (p=0.03 and 0.04 respectively). Death was similar in both groups. When performing regression analysis, after adjusting for demographics, APACHE II score and cardiac history, use of nCCB was associated with administration of higher concomitant vasopressors (p=0.004) and at least one inotrope (p=0.043), use of BB was associated with higher ICU and hospital LOS (p=0.047, p=0.002 respectively) while APACHE II score was the only factor associated with death (p=0.011). CONCLUSION: Patients on BB and/or nCCB have a delayed recovery but similar mortality to those off these medications, despite an increase in age and prevalence of cardio-vascular disease.
CLINICAL IMPLICATIONS: Preadmission use of BB and nCCB may exert a long-term “protective” effect on septic patients admitted to the ICU. DISCLOSURE: Omar Nehme, No Financial Disclosure Information; No Product/Research Disclosure Information Tuesday, October 28, 2008 1:00 PM - 2:15 PM