Push dose pressors: Experience in critically ill patients outside of the operating room.
Am J Emerg Med
; 37(3): 494-498, 2019 03.
Article
em En
| MEDLINE
| ID: mdl-30553634
ABSTRACT
PURPOSE:
Evaluate push dose vasopressor (PDP) practice patterns, efficacy, and safety in critically ill patients.METHODS:
Critically ill patients receiving phenylephrine or ephedrine PDP from November 2015-March 2017 were included. Patient demographics, medication administration details, vital signs pre- and post-administration, adverse effects, and medications errors were collected. Descriptive data are presented and comparisons were made with paired samples t-test, Wilcoxon Rank Sum and Chi-squared analysis or Fisher's Exact Test as appropriate.RESULTS:
A total of 146 patients (155 PDP events) were included; mean age 64.5⯱â¯13.3â¯years and 66.4% males, respiratory failure (39.8%) or sepsis (24.9%) admission diagnosis. The surgical intensive care unit (ICU) (44.5%) and medical ICU (33.6%) used PDPs most often, and during the peri-intubation period (57.3%) or for other transient hypotension (38.2%). Following PDP, mean systolic blood pressure (BP), diastolic BP, and heart rate (HR) increased 32.5% (80 to 106â¯mmHg), 27.2% (48 to 61â¯mmHg), and 6.4% (93 to 99â¯bpm), respectively. There were 17 (11.6%) adverse events; most often related to excessive increases in BP or HR and one incidence of dysrhythmia. Thirteen patients (11.2%) had a dose related medication error (phenylephrine dose >200⯵g or ephedrine dose >25â¯mg), nine (6.2%) received PDP with normal/elevated hemodynamics (systolic BPâ¯>â¯100â¯mmHg or HRâ¯>â¯160â¯bpm) and 15% while on a continuous infusion vasopressor.CONCLUSION:
PDPs were used in a variety of patient diagnoses and for select indications. Overall, they were efficacious but associated with adverse drug events and medication errors.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Vasoconstritores
/
Cuidados Críticos
/
Hipotensão
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
Limite:
Aged
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Female
/
Humans
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Male
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Middle aged
Idioma:
En
Revista:
Am J Emerg Med
Ano de publicação:
2019
Tipo de documento:
Article