Adoption of a Novel Vasopressor Agent in Critically Ill Adults
Bibliographic record
Abstract
In December 2017, angiotensin II (ATII) intravenous infusion was approved in the United States for adults with septic or other distributive shock (1).This approval was based on a phase II clinical trial that demonstrated increased mean arterial pressure among patients with septic shock on norepinephrine randomized to titrated ATII versus placebo (2); subsequent practice patterns and clinical adoption were unclear.Therefore, we sought to describe ATII use in a large sample of critically ill adults receiving vasopressor therapy. MethodsWe used the PINC AI Healthcare Database, capturing approximately 25% of the acute care hospitalizations in the United States (3), to identify adults who were admitted to intensive care units (ICUs) from January 1, 2018, to December 31, 2020, with charge codes for at least one dose of an intravenous medication with vasopressor effects (ATII, epinephrine, norepinephrine, phenylephrine, or vasopressin).We excluded patients in hospitals with fewer than one patient in each study month or fewer than 25 patients who met inclusion criteria.In a secondary analysis, we restricted the cohort to patients with septic shock (identified by International Classification of Diseases, 10th revision, codes using Angus criteria) (4).The primary outcome was receipt of ATII (during hospitalization).Secondary outcomes included the number and days of vasopressors received and the timing of ATII administration relative to other vasopressors.Hospital characteristics included teaching status, the presence of a cardiac surgery program (5), and safety-net hospital status.Patient characteristics included demographics; comorbidities (6-8); acute organ dysfunctions (4); shock diagnoses and thrombotic diagnostic codes present on admission (9-12); and mechanical ventilation (13), major surgery (14), cardiopulmonary bypass (5), and renal replacement therapy during hospitalization (15) from diagnosis and charge codes.We determined the proportion of patients who received ATII overall, by hospital, and by study month, and then compared the characteristics of patients who received ATII with those who did not, using standardized mean differences (SMDs) (16).To characterize
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".