Associação entre Drogas Vasoativas e Mortalidade em Pacientes Críticos

Revisão Sistemática da Literatura

Abstract

Introduction: In Intensive Care Units (ICUs), circulatory failure, manifested as shock, is a critical condition requiring immediate intervention. Vasoactive drugs (VADs) are the cornerstone of hemodynamic support to restore vascular tone and maintain blood pressure. Although essential, the use of these medications is common—affecting approximately 40% of ICU patients—and is inevitably linked to poorer clinical outcomes and a significant increase in mortality, reflecting the relentless severity of the underlying disease. Objectives: The main objective of this study was to evaluate, through a systematic literature review, the association between the use of vasoactive drugs and mortality in adult ICU patients. Methodology: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The research question was structured using the PICO strategy. The search was conducted in the PubMed/MEDLINE, Embase, Scopus, and Web of Science databases, including studies published in the last five years (2020 to 2025). Eligibility criteria focused on observational studies and clinical trials with adults in the ICU who used vasoactive drugs (VAS) and assessed mortality. In total, 23 studies comprised the final synthesis. Due to the significant heterogeneity among the designs and populations, a narrative synthesis of the findings was chosen. Conclusion: The systematic review confirms that the use of VAS is a robust and independent predictor of increased mortality in critically ill patients in various ICU populations. The intensity of vasoactive support, quantified by scores such as the Vasoactive Inotropic Score (VIS) and the Blood Pressure Response Index (BPRI), correlates directly with a worse prognosis. Given these findings, rigorous monitoring of the dose and hemodynamic response to VAS is fundamental for risk stratification and to guide therapeutic optimization.