Lecture on Vasopressors in Trauma

Introduction

• Speaker: Dennis Kim
• Event: Recess X 2022
• Topic: Controversial use of vasopressors in trauma
• Duration: 10-12 minutes
• No financial disclosures

Lecture Outline

1. Vasopressors as a 'Never Event'
2. Rationale for Their Use
3. Literature Review
4. Concluding Points

Vasopressors as a 'Never Event'

• Question: "Never have I ever administered vasopressors to a trauma patient?"
• Common Use Cases:
  • Spinal cord injuries (e.g., cervical spinal cord injury with neurogenic shock)
  • Prolonged pre-hospital transport times
  • Post-intubation hypotension

Rationale for Use

• Arguments for Vasopressors:
  • Excessive fluid resuscitation can lead to complications like:
    • Abdominal compartment syndrome
    • ARDS
    • Cardiac and pulmonary dysfunction
    • Inflammation and coagulopathy
  • Volume sparing resuscitation using vasopressors may reduce morbidity
  • Hormonal deficiencies in hemorrhagic shock (e.g., vasopressin) leading to catecholamine resistance
  • Shunting blood to critical organs and assisting with hemostasis

Literature Review

• Retrospective Reviews:
  • Sperian et al. Study:
    • Early vasopressor use linked to higher mortality but involved severely injured patients
    • Phenylephrine, norepi, and dopamine associated with increased mortality
    • Volume status didn’t impact mortality significantly
  • Avert Trial (2019):
    • Studied low-dose AVP supplementation
    • Decreased transfusion requirements

Key Findings

• Challenges in Studies:
  • Selection bias and unequal baseline demographics
• Observations:
  • Early vasopressor use often linked to death
  • Vasopressors may be markers of injury severity rather than cause of mortality

Take-home Points

• Literature Insights:
  • Predominantly observational studies
  • Early vasopressor use associated with adverse outcomes
• Primary Focus:
  • Identify and stop bleeding
• Vasopressors Post-Bleeding Control:
  • Low-dose vasopressors, particularly vasopressin, may be reasonable after bleeding control

Conclusion

• Ongoing Questions:
  • Definition of 'early' intervention
  • Impact on elderly and brain-injured patients
  • Variability in vasopressor effects
• Summary:
  • Vasopressors are not always harmful but should be considered in context
  • Emphasize bleeding control and injury severity assessment.

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Notes based on Dennis Kim's lecture at Recess X 2022.

[Music] was playing during transitions.