INTERVAL Impact of Nurses' Interventions on Vasopressors Weaning: the INTERVAL Study

Objectives: Although daily managed by ICU nurses, weaning from vasopressors has rarely been studied. The aim of our study was to determine if the increase of number of interventions carried out by nurses on vasopressors infusion regimen reduces catecholamine's treatment duration. Patients and methods: We have conducted an observational prospective study in 21 ICUs. All patients treated with vasopressors (epinephrine and/or norepinephrine) during the study period were included. The number of interventions (vasopressors infusion regimen increase or decrease) carried out by the nurse in charge of the patient was noted every 4 h and divided by the total duration of administration. The current vasopressor dosage and the patient's mean arterial blood pressure (MAP) were also recorded. Factors influencing the rapidity of withdrawal from vasopressors were also analyzed. Results: We have included 226 patients whose mean age was 65 +/- 14 years. The mean vasopressors treatment duration was 71.6 (+/- 81) h. The number of nurse interventions per 4 h was 1.9 (+/- 2.8). The duration of administration of vasopressors was significantly lower when the number of interventions increased (P = 0.04). In a multivariable analysis, SAPSII (Simplified Acute Physiology Score 2) value, MAP, existence of a weaning protocol, and the day period were associated to an increased number of nurse interventions. Conclusion: The number of nurse interventions related to vasopressors treatment regimen modification was inversely correlated to vasopressors treatment duration. Additional studies were warranted to assess the impact of these interventions on patients' prognosis.