Vasopressor use patterns in Tanzanian hospitals

Abstract

Background:  

Sepsis carries a disproportionately high mortality in Sub-Saharan Africa (SSA). Emerging data suggest patients in SSA who receive large fluid boluses may have increased mortality, and that earlier administration of vasopressors may have clinical benefit. Little data exists on how vasopressors are currently used in Tanzania and other countries in SSA, limiting an understanding of the feasibility of this strategy. The goal of our study was to describe the current use of vasopressors in Tanzania including route of administration, monitoring, and titration parameters.

Methods: We conducted a cross-sectional web-based survey of clinical staff (physicians and nurses) in hospitals throughout Tanzania who manage sepsis in adult and pediatric patients as part of their clinical practice. We included hospitals that had at least one specialty-trained emergency physician on site, who served as a point of contact to distribute and collect data.  Survey questions were presented in English and Swahili. Results were summarized with descriptive statistics. 

Results: Sixty-five providers completed the survey from 19 hospitals. Of 54 respondents who routinely used vasopressors, most (75.0%) typically infuse these medications via peripheral intravenous lines. Most (62.3%) reported that patients receiving vasopressors are almost always on continuous cardiac monitoring; while 24.6% stated this was the case half the time or more, while two respondents (3.8%) stated that patients receiving vasopressors were almost never on cardiac monitoring. Intermittent cuff blood pressure measurements were by far the most common (88.7%) methodology to titrate vasopressors, followed by physical exam markers of perfusion (54.7%), and laboratory studies (17.0%).

Conclusions: In Tanzania, vasopressors are often administered through peripheral venous lines, and while continuous cardiac monitoring during administration of vasopressors is common this practice is not universal. Our findings provide important insights into current practice, though further studies are needed to assess the impact of these practice patterns on sepsis outcomes.