A survey on the use of vasopressor and inotropic agents over three monthsat the Kenyatta national hospital

Abstract

Background In Kenyatta National Hospital vasopressor and inotropic agents are used in specialized units CCU and HDU. Knowledge of the varied pharmacology and mechanism of action of the agents allows for proper selection and thus desired outcome. This is done by medical staff with appropriate experience and training. These drugs are known to impact on patient outcome though guidelines are not readily available to give guidance on management and allow for standardization of treatment. Therefore individual experience and preference determines selection. Objective To survey the use of vasopressor and inotropic agents over three months at KNH. Study design An observational, descriptive study. Setting Kenyatta National Hospital-Critical care unit, emergency ward, high dependency units. It was carried out over three months from approval of the study. Study population Patients admitted in the above units on inotrope or vasopressor agent that was initiated at KNH Sample size The sample size was determined by the modified Fisher’s formula: =70 Sampling procedure Convenient sampling was used to select the patients. The eligible patients were recruited consecutively into the study using the inclusion criteria Inclusion criteria;  Patients in main CCU and Emergency ward on inotropic/vasopressor agent initiated at KNH.  Patients who gave consent to participate in the study. Exclusion criteria;  Patients who didn't consent to participate in the study.  Patients transferred to KNH who were already on inotropic or vasopressor therapy. Study variables These included identifying the types of inotropic/vasopressor agents available, document their indications, modes of haemodynamic monitoring and the techniques used to administer the agents. Data management and analysis Data was presented as numbers (%) or mean+ SD and summerized using tables, histograms and pie-charts as appropriate. Descriptive and inferential statistics were used to analyze the data. All analyses were performed using SPSS (statistical package for the social sciences) Statistics (version 20, Chicago, IL). Results Data from 70 patients were collected and recorded. 94% were adult patients. 59% of the patients were female. The leading cause for initiating inotropes was septic shock (48.6%). The inotropes that are available for use were dopamine, norepinephrine, epinephrine and dobutamine in order of most prescribed agent. In patients with septic shock norepinephrine and dopamine were the inotropes of choice while in cardiogenic shock epinephrine and dobutamine were the inotropes of choice. 97% of the time inotropes were initiated on the same day. The mode of haemodynamic monitoring commonly used is basic monitoring (defined in this study as heart rate, pulse oximeter, central venous pressure and non-invasive blood pressure). Through the study quick change was used in substituting inotrope infusion. Infusion pumps were used to administer the agents 100% of the time. Conclusion The use of inotropes/vasopressors at the Kenyatta National Hospital is fairly well executed in the critical care areas.