The Association Between Increasing Vasoactive Medication Dose and Adverse Events During Physical and Occupational Therapy Sessions

Introduction: The purpose of this study was to examine the incidence of adverse events (AEs) during physical and occupational therapy sessions in which the doses of vasoactive medications were increased to allow for maintenance of blood pressure during mobility progression. A secondary purpose was to determine factors associated with AEs. Review of Literature: Recent research has found a low rate of AEs when mobilization is performed on high doses of vasoactive medications. There has been no published work regarding the feasibility or safety of increasing vasoactive medication dose to progress mobility, though this practice occurs frequently in some intensive care units. Methods: A retrospective medical record review of 44 patients participating in 100 physical and/or occupational therapy sessions was performed. Data regarding patient demographics, illness severity, medication and medication titration, comorbid conditions, mobility level, and AEs were collected. Descriptive statistics were calculated, and relationships between variables were explored. Results: Eight patients (18%) experienced nine AEs across nine physical therapy sessions (9%). AEs were not correlated with illness severity ( r pb = .024, P = .81), medication dose during the session (τ b = .051, P = .55), amount of medication dose increase during the session (τ b = −.027, P = .75), or mobility level ( P = .755). There was a higher incidence of AEs in patients with chronic respiratory disease compared to those without ( P = .011). Discussion and Conclusion: This was the first study to investigate the practice of titrating vasoactive medications to allow for increased mobility. While this sample had a higher rate of AEs than observed in previous studies involving early mobilization, all AEs were transient and without long-term consequence. Titration of vasoactive medications to allow for increased levels of mobility may be done without AEs in some patients, though further investigation is needed.