Current guidelines recommend extubation only if a patient is not receiving vasopressor therapy or is receiving minimal doses of vasopressors. However, recent data indicate that extubation of patients receiving higher vasopressor doses may be safe. This study was undertaken to examine practices regarding extubation of patients receiving vasopressor therapy reported by clinician respondents to a survey by the Michigan Health and Hospital Association Keystone Center. One-third of respondents indicated that they would extubate a patient receiving vasopressors, and one-quarter indicated that it depended on the agent used, but more than half reported that their unit did not have a vasopressor use protocol or they did not know whether it did. Practices regarding extubation of patients receiving vasopressor therapy differed significantly by unit type and by role as a direct care provider. These data indicate that patient and clinician factors may drive practice patterns. Additional research to inform guidelines and local protocols is warranted.
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1 March 2023
Brief Report|
March 01 2023
Extubation of Patients Receiving Vasopressor Infusions: Results of a Survey on Statewide Practices
Deena Kelly Costa, PhD, RN;
Deena Kelly Costa is an associate professor, Yale School of Nursing, Orange, Connecticut, and Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut.
Corresponding author: Deena Kelly Costa, PhD, RN, Yale School of Nursing, 400 W Campus Dr, Office 20510, Orange, CT 06477 (email: deena.costa@yale.edu).
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Hannah C. Ratliff, BSN, RN;
Hannah C. Ratliff, BSN, RN
Hannah C. Ratliff is a doctoral student, University of Michigan School of Nursing, Ann Arbor.
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Meghan Kelly, BSN, RN;
Meghan Kelly, BSN, RN
Meghan Kelly is a staff nurse, Northwestern University Hospital, Chicago, Illinois.
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Hallie C. Prescott, MD, MSc;
Hallie C. Prescott, MD, MSc
Hallie C. Prescott is an associate professor, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan School of Medicine; and a research investigator at the VA Center for Clinical Management Research and the Institute for Healthcare Policy and Innovation, University of Michigan; Ann Arbor, Michigan.
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Elizabeth Munroe, MD;
Elizabeth Munroe, MD
Elizabeth Munroe is a pulmonary and critical care medicine fellow, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor.
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Robert C. Hyzy, MD;
Robert C. Hyzy, MD
Robert C. Hyzy is a clinical professor, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan School of Medicine and medical director of the Critical Care Medicine Unit, Michigan Medicine, Ann Arbor.
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Sam Watson, MSA;
Sam Watson, MSA
Sam Watson is senior vice president for patient safety and quality, Michigan Health and Hospital Association and executive director, MHA Keystone Center, Okemos, Michigan.
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Corine Nowak, MHA;
Corine Nowak, MHA
Corine Nowak is a quality assurance manager, Origami Rehabilitation, Mason, Michigan.
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Theodore J. Iwashyna, MD, PhD
Theodore J. Iwashyna, MD, PhD
Theodore J. Iwashyna is a professor of medicine, Division of Pulmonary Medicine, Department of Medicine, Johns Hopkins University School of Medicine, and a professor of public health, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
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Am J Crit Care (2023) 32 (2): 127–130.
Citation
Deena Kelly Costa, Hannah C. Ratliff, Meghan Kelly, Hallie C. Prescott, Elizabeth Munroe, Robert C. Hyzy, Sam Watson, Corine Nowak, Theodore J. Iwashyna; Extubation of Patients Receiving Vasopressor Infusions: Results of a Survey on Statewide Practices. Am J Crit Care 1 March 2023; 32 (2): 127–130. doi: https://doi.org/10.4037/ajcc2023489
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