Vasopressor use in the intensive care unit: What matters most to patients and families

Vasopressors are essential medications used in the intensive care unit (ICU) to maintain blood pressure in patients with life-threatening hypotension. While vasopressors can be lifesaving, they carry potential risks, such as reducing blood flow to certain organs and increasing the work that the heart must do to pump blood to the body. Despite their frequent use, little is known about how patients, families, and the public perceive the benefits and risks of vasopressor therapy.

The objective of this study was to explore perspectives of former ICU patients, their families, and the public on the use, and benefits, and risks of vasopressor therapy in the ICU.

We conducted a qualitative study using interviews and focus groups with 25 participants: nine former ICU patients (36%), eight family members (32%), and eight public members (32%). Participants received education on hypotension and vasopressor use before discussions. Topics included factors influencing willingness to receive vasopressors, perceived benefits and risks, and priority outcomes. Data were analysed using inductive content analysis.

Perspectives were influenced by three contextual factors: (i) level of consciousness during vasopressor administration; (ii) pre-existing health conditions or medications; and (iii) life stage. Willingness to undergo therapy was shaped by a focus on stabilisation and survival, perceived low risk of side effects, belief that side effects could be managed, and trust in clinicians. Participants also expressed concerns about social, physical, and mental wellbeing challenges following vasopressor therapy.

While vasopressors were broadly accepted as lifesaving, participants emphasised the importance of aligning treatment decisions with long-term outcomes. Many of the themes identified overlap with general ICU survivorship concerns, highlighting the need for improved communication about risks and benefits and patient-centred discussions regarding ICU therapies and post-ICU outcomes.