Real-Vaso Survey:Evaluation of the real world use of vasopressin in ICU

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* 3. Experience as intensivist

Not specialized yet, in training

<2 y

2-5y

>5y

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* 4. Type of institution

University Hospital

Non-university public hospital

Private Hospital

other

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* 5. Number of ICU beds

5-10

11-15

16-20

>20

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* 6. What is the nurse:patient ratio in you unit?

1:1

1:2

1:2.5

1:3

1:4

Other

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* 7. Vasopressin introduction
In which situation would you not introduce vasopressin?

History of GI vasculopathy

History of systemic sclerosis

History of vasospatic diseases (Raynaud disease, acrocyanosis, livedo reticularis)

History of peripheral vasculopathy

Peripheral malperfusion already present (digital ischemia, non-occlusive mesenteric ischemia)

Postoperative period with vascular anastomosis

None

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* 8. Feared secondary effects while using vasopressin?

Digital ischemia

Digestive ischemia

Unclear impact on outcome

Hyponatremia

Cardiac arrhythmias

None

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* 9. If vasopressin is contraindicated, which vasopressor you would use?

Norepinephrine

Epinephrine

Angiotensin II

Phenylephrine

Methylene blue

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* 10. In which situations you would mostly use vasopressin?

Septic shock refractory to initial resuscitation

Septic shock with high risk of renal failure

Septic shock in a patient with ARDS

Septic shock in a cirrhotic patient

Septic shock with atrial arrhythmia

Refractory vasoplegic shock (other than septic) without reduced cardiac function

Refractory vasoplegic shock (other than septic) with reduced cardiac function

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* 11. At which step of resuscitation do you start vasopressin?

First line vasopressor

Second line, after initial resuscitation using fluid and norepinephrine

Third line, as rescue therapy

Early in the vasopressive therapy to reach pressure goal and spare catecholamine in order to decrease catecholamine load

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* 12. What is you first line vasopressor?

Norepinephrine

Epinephrine

Vasopressin

Angiotensin II

Phenylephrine

Methylene blue

Dopamine

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* 13. If vasopressin is your first line agent, what is your second line vasopressor?

Norepinephrine

Epinephrine

Angiotensin II

Phenylephrine

Methylene blue

Dopamine

Vasopressin is not my first line vasopressor

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* 14. If vasopressin is your second line agent, what is your first line vasopressor?

Norepinephrine

Epinephrine

Angiotensin II

Phenylephrine

Methylene blue

Dopamine

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* 15. If you do not use vasopressin as a second line agent, what is your second line vasopressor?

Norepinephrine

Epinephrine

Angiotensin II

Phenylephrine

Methylene blue

Dopamine

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* 16. If vasopressin is your third line agent, what is your second line vasopressor?

Norepinephrine

Epinephrine

Angiotensin II

Phenylephrine

Methylene blue

Dopamine

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* 17. If you have to choose a norepineprine dose as a trigger to initiate vasopressin, what dose would it be (Noradrenaline equivalent dose µg/kg/min)?

none

0.25-0.5

0.5-1

1-2

2-5

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* 18. If you have to choose a duration of noradrenaline support as a trigger to initiate vasopressin, what duration would it be (hours of support)?

<2h

2-4h

4-6h

6-8h

8-12h

>12h

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* 19. If you have to choose the association of dose and duration of noradrenaline support as a trigger to initiate vasopressin, what would it be (Noradrenaline equivalent dose µg/kg/min and duration of support)?

0.25 for <2 hours

0.5 for <2 hours

1 for <2 hours

>2 for <2 hours

0.25 for 2-6 hours

0.5 for 2-6 hours

1 for 2-6 hours

>2 for 2-6 hours

0.25 for >6 hours

0.5 for >6 hours

1 for >6hours

>2 for >6 hours

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* 20. If you have to choose a clinical sign as a trigger to initiate vasopressin, what would it be?

Persistent skin mottling

Oliguria

Persistent hyperlactatemia

Persistent low systolic arterial pressure

Persistent low mean arterial pressure

Persistent low diastolic arterial pressure

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* 21. If you have to use only one to trigger vasopressin therapy, which one would it be?

Dose

Duration

Clinical signs

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* 22. Do you use a combination of those elements?

Dose & duration

Dose & clinical response

Duration & clinical signs

Dose & Duration & Clinical signs & Clinical response

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* 23. What vasopressin starting dose do you use?

0.0001 UI/kg/min

0.0005 UI/kg/min

0.001 UI/kg/min

Other (specify in next question)

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* 24. What vasopressin starting dose do you use (UI/kg/min) if not mention in the last question?

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* 25. What vasopressin dose do you use during the patient’s resuscitation?

Fixed dose same as initial dose

Fixed dose at 0.01 UI/min

Fixed dose at 0.02 UI/min

Fixed dose at 0.03 UI/min

Fixed dose at 0.05 UI/min

Fixed dose at 0.06 UI/min

Fixed dose at 0.0001 UI/kg/min

Fixed dose at 0.01 UI/kg/min

Titration to clinical response

Other (specify in next question)

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* 26. What fixed vasopressin dose do you use during the patient’s resuscitation (UI/kg/min) if not mention in the last question?

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* 27. What is the maximal vasopressin dose you may use?

0.03 UI/min

0.05 UI/min

0.06 UI/min

0.001 UI/kg/min

0.002 UI/kg/min

0.01 UI/kg/min

0.05 UI/kg/min

No maximal dose

Other (specify in next question)

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* 28. What is the maximal vasopressin dose you may use (UI/kg/min) if not mention in the last question?

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* 29. How do you manage the cessation of vasopressin support with another vasopressor?

I stopped vasopressin in parallel to another vasopressor

I stopped vasopressin after norepinephrine or first line vasopressor regardless of the vasopressor use

I stopped vasopressin first

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* 30. How do you stop vasopressin support?

Progressive decreasing of the vasopressin support

Abrupt cessation of the vasopressin support

Real-Vaso Survey:Evaluation of the real world use of vasopressin in ICU

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* 1. Location

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* 2. Type of ICU

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* 3. Experience as intensivist

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* 4. Type of institution

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* 5. Number of ICU beds

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* 6. What is the nurse:patient ratio in you unit?

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* 7. Vasopressin introductionIn which situation would you not introduce vasopressin?

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* 8. Feared secondary effects while using vasopressin?

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* 9. If vasopressin is contraindicated, which vasopressor you would use?

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* 10. In which situations you would mostly use vasopressin?

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* 11. At which step of resuscitation do you start vasopressin?

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* 12. What is you first line vasopressor?

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* 13. If vasopressin is your first line agent, what is your second line vasopressor?

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* 14. If vasopressin is your second line agent, what is your first line vasopressor?

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* 15. If you do not use vasopressin as a second line agent, what is your second line vasopressor?

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* 16. If vasopressin is your third line agent, what is your second line vasopressor?

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* 17. If you have to choose a norepineprine dose as a trigger to initiate vasopressin, what dose would it be (Noradrenaline equivalent dose µg/kg/min)?

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* 18. If you have to choose a duration of noradrenaline support as a trigger to initiate vasopressin, what duration would it be (hours of support)?

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* 19. If you have to choose the association of dose and duration of noradrenaline support as a trigger to initiate vasopressin, what would it be (Noradrenaline equivalent dose µg/kg/min and duration of support)?

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* 20. If you have to choose a clinical sign as a trigger to initiate vasopressin, what would it be?

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* 21. If you have to use only one to trigger vasopressin therapy, which one would it be?

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* 22. Do you use a combination of those elements?

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* 23. What vasopressin starting dose do you use?

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* 24. What vasopressin starting dose do you use (UI/kg/min) if not mention in the last question?

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* 25. What vasopressin dose do you use during the patient’s resuscitation?

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* 26. What fixed vasopressin dose do you use during the patient’s resuscitation (UI/kg/min) if not mention in the last question?

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* 27. What is the maximal vasopressin dose you may use?

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* 28. What is the maximal vasopressin dose you may use (UI/kg/min) if not mention in the last question?

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* 29. How do you manage the cessation of vasopressin support with another vasopressor?

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* 30. How do you stop vasopressin support?

Real-Vaso Survey:
Evaluation of the real world use of vasopressin in ICU

* 7. Vasopressin introduction
In which situation would you not introduce vasopressin?