Impact of delayed transition off intravenous vasoactive agents for aortic dissection on intensive care unit length of stay

BACKGROUND: The initial management of acute aortic dissection centers around rapid control of blood pressure and heart rate, commonly requiring initiation of continuous intravenous (IV) antihypertensive agents and intensive care unit (ICU) admission. However, there is limited guidance for when and how to transition off IV infusions to enteral agents, potentially extending ICU length of stay (LOS) in stable patients who are otherwise ready for floor transfer. The objective of this study is to compare the impact of rapid vs. slow transition from IV to enteral vasoactive medications on ICU LOS. METHODS: In this retrospective cohort study of 56 adult patients admitted with aortic dissection requiring IV vasoactive infusions for >6 hours, patients were grouped by time required to fully transition from IV to enteral vasoactive agents. Patients who transitioned in ≤72 hours were considered the “rapid” group, and the “slow” group required >72 hours to fully convert. The primary endpoint was ICU LOS. RESULTS: For the primary endpoint, the median ICU LOS was 3.6 days for the “rapid” group, compared to 7.7 days in the “slow” group (P<0.001). The “slow” group required a significantly longer duration of IV vasoactive infusions (115.7 vs. 36.0 hours, P<0.001) and also trended towards longer median hospital LOS. The two cohorts had similar incidences of hypotension. CONCLUSIONS: In this study, rapid transition to enteral antihypertensives within 72 hours was associated with a shorter ICU LOS without an increase in hypotension.