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1.
Med Klin Intensivmed Notfmed ; 116(6): 541-553, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34338810

RESUMO

Circulatory shock requires treatment of the underlying pathology in addition to supportive pharmacological therapy that is guided by hemodynamic monitoring. Based on the evaluation of the patient's volume, perfusion and cardiac status, the following therapeutic goals should be achieved: (1) Normalization of the intra- and extravascular fluid volume. (2) Provision of sufficient perfusion pressure and organ perfusion. (3) Optimization of cardiac function including protecting an ischemic and exhausted myocardium from overload. The most important therapeutic substances are balanced electrolyte solutions and the vasopressor noradrenaline. Because there is little scientific evidence for the use of alternative drugs, these should only be given if there is a good pathophysiologic rationale and if their effect is continuously monitored and re-evaluated.


Assuntos
Choque , Hidratação , Hemodinâmica , Humanos , Monitorização Fisiológica , Norepinefrina , Choque/tratamento farmacológico , Vasoconstritores/efeitos adversos
3.
Laryngoscope ; 131(10): 2319-2322, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34156097

RESUMO

OBJECTIVES/HYPOTHESIS: To compare the hemostatic effects of commonly used concentrations of topical epinephrine in tympanoplasty. STUDY DESIGN: Prospective, randomized, controlled clinical trial. METHODS: Patients undergoing tympanoplasty were randomized to receive topical epinephrine at 1:1,000 or 1:10,000. With the investigators blinded, hemostasis was assessed with a modified Boezaart scale. Vasoconstriction was measured by laser Doppler. Blood pressure and pulse were tracked. RESULTS: Thirty patients, 4 to 84 years old, were studied, with 15 patients per group. Boezaart scores dropped a mean of 67% and 62% with 1:1,000 and 1:10,000, respectively (P = .44). Capillary blood flow decreased a mean of 50.4% and 50.9% with 1:1,000 and 1:10,000, respectively (P = .95). The mean change in heart rate and mean arterial pressure after topical epinephrine exposure were -4.9 and -0.73 beats per minute (P = .15), and -0.60 and -0.73 mmHg (P = .96) for 1:1,000 and 1:10,000 respectively. No adverse events occurred in either group. CONCLUSIONS: Topical epinephrine at 1:10,000 has hemostatic efficacy comparable to 1:1,000 in tympanoplasty. Although both concentrations appear safe, use of topical epinephrine 1:10,000 should be considered over 1:1,000 to minimize the potential for adverse events. LEVEL OF EVIDENCE: 2 Laryngoscope, 131:2319-2322, 2021.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Epinefrina/administração & dosagem , Hemostasia Cirúrgica/métodos , Timpanoplastia/efeitos adversos , Vasoconstritores/administração & dosagem , Administração Tópica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Pressão Sanguínea/efeitos dos fármacos , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Epinefrina/efeitos adversos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Timpanoplastia/estatística & dados numéricos , Vasoconstrição/efeitos dos fármacos , Vasoconstritores/efeitos adversos , Adulto Jovem
5.
Crit Care ; 25(1): 146, 2021 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-33863361

RESUMO

BACKGROUND: It is unclear whether vasopressors can be safely administered through a peripheral intravenous (PIV). Systematic review and meta-analysis methodology was used to examine the incidence of local anatomic adverse events associated with PIV vasopressor administration in patients of any age cared for in any acute care environment. METHODS: MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of controlled trials, and the Database of Abstracts of Reviews of Effects were searched without restriction from inception to October 2019. References of included studies and related reviews, as well as relevant conference proceedings were also searched. Studies were included if they were: (1) cohort, quasi-experimental, or randomized controlled trial study design; (2) conducted in humans of any age or clinical setting; and (3) reported on local anatomic adverse events associated with PIV vasopressor administration. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials or the Joanna Briggs Institute checklist for prevalence studies where appropriate. Incidence estimates were pooled using random effects meta-analysis. Subgroup analyses were used to explore sources of heterogeneity. RESULTS: Twenty-three studies were included in the systematic review, of which 16 and 7 described adults and children, respectively. Meta-analysis from 11 adult studies including 16,055 patients demonstrated a pooled incidence proportion of adverse events associated with PIV vasopressor administration as 1.8% (95% CI 0.1-4.8%, I2 = 93.7%). In children, meta-analysis from four studies and 388 patients demonstrated a pooled incidence proportion of adverse events as 3.3% (95% CI 0.0-10.1%, I2 = 82.4%). Subgroup analyses did not detect any statistically significant effects associated with stratification based on differences in clinical location, risk of bias or design between studies, PIV location and size, or vasopressor type or duration. Most studies had high or some concern for risk of bias. CONCLUSION: The incidence of adverse events associated with PIV vasopressor administration is low. Additional research is required to examine the effects of PIV location and size, vasopressor type and dose, and patient characteristics on the safety of PIV vasopressor administration.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Vasoconstritores/efeitos adversos , Cateterismo Periférico/métodos , Humanos , Vasoconstritores/uso terapêutico
6.
Adv Skin Wound Care ; 34(5): 273-277, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33852464

RESUMO

ABSTRACT: Norepinephrine is used in the acute care setting to establish and maintain hemodynamic stability in patients with hypotension. Although it is often a lifesaving medication, norepinephrine may lead to profound vascular insufficiency in the extremities, resulting in dry gangrene and skin necrosis. The purpose of this article is to present a case series of skin complications related to treatment with norepinephrine and review the pathophysiology behind these complications. The authors also explore risk stratification as it relates to history and clinical presentation with subsequent focus on contingencies to mitigate the adverse effects of vasoconstriction on peripheral tissues.


Assuntos
Gangrena/etiologia , Isquemia/etiologia , Norepinefrina/efeitos adversos , Idoso , Estudos de Casos e Controles , Feminino , Gangrena/fisiopatologia , Humanos , Isquemia/complicações , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Norepinefrina/farmacologia , Doenças Vasculares Periféricas/etiologia , Vasoconstritores/efeitos adversos , Vasoconstritores/farmacologia
7.
J Drugs Dermatol ; 20(3): 252-258, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33683083

RESUMO

BACKGROUND: Psoriasis is a chronic, inflammatory disease that may differ in prevalence and clinical presentation among patients from various racial and ethnic groups. Two phase 3 studies demonstrated efficacy and safety of halobetasol propionate (HP) 0.01% lotion in the treatment of moderate-to-severe plaque psoriasis (NCT02514577, NCT02515097). These post hoc analyses evaluated HP 0.01% lotion in Hispanic participants. METHODS: Participants were randomized (2:1) to receive once-daily HP or vehicle lotion for 8 weeks, with a 4-week posttreatment follow-up. Post hoc efficacy assessments in Hispanic participants (HP, n=76; vehicle, n=43) included treatment success (≥2­grade improvement in Investigator’s Global Assessment and score of ‘clear’ or ‘almost clear’), psoriasis signs, and affected body surface area (BSA). Treatment-emergent adverse events (TEAEs) were evaluated. RESULTS: At week 8, 38.8% of participants achieved treatment success with HP versus 10.3% on vehicle (P=0.001). HP­treated participants achieved greater improvements in psoriasis signs, compared with vehicle (P<0.01 all). HP group had a greater reduction in affected BSA versus vehicle (P=0.001). Treatment-related TEAEs with HP were application site infection and dermatitis (n=1 each). CONCLUSIONS: Once-daily HP 0.01% lotion was associated with significant reductions in disease severity in Hispanic participants with moderate-to-severe psoriasis, with good tolerability and safety over 8 weeks. J Drugs Dermatol. 2021;20(3):252-258. doi:10.36849/JDD.5698.


Assuntos
Clobetasol/análogos & derivados , Dermatite de Contato/epidemiologia , Fármacos Dermatológicos/administração & dosagem , Psoríase/tratamento farmacológico , Vasoconstritores/administração & dosagem , Administração Cutânea , Adulto , Clobetasol/administração & dosagem , Clobetasol/efeitos adversos , Dermatite de Contato/etiologia , Fármacos Dermatológicos/efeitos adversos , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psoríase/diagnóstico , Índice de Gravidade de Doença , Resultado do Tratamento , Vasoconstritores/efeitos adversos
10.
N Engl J Med ; 384(9): 818-828, 2021 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-33657294

RESUMO

BACKGROUND: The vasoconstrictor terlipressin is used for type 1 hepatorenal syndrome (HRS-1) in many parts of the world and is part of the clinical practice guidelines in Europe. METHODS: We conducted a phase 3 trial to confirm the efficacy and safety of terlipressin plus albumin in adults with HRS-1. The patients were randomly assigned in a 2:1 ratio to receive terlipressin or placebo for up to 14 days; in both groups, concomitant use of albumin was strongly recommended. The primary end point was verified reversal of HRS, defined as two consecutive serum creatinine measurements of 1.5 mg per deciliter or less at least 2 hours apart and survival without renal-replacement therapy for at least 10 days after the completion of treatment. Four prespecified secondary end points were analyzed with the Hochberg procedure to account for multiple comparisons. RESULTS: A total of 300 patients underwent randomization - 199 were assigned to the terlipressin group and 101 to the placebo group. Verified reversal of HRS was reported in 63 patients (32%) in the terlipressin group and 17 patients (17%) in the placebo group (P = 0.006). With respect to the prespecified secondary end points, HRS reversal, defined as any serum creatinine level of 1.5 mg per deciliter or less during the first 14 days, was reported in 78 patients (39%) in the terlipressin group and 18 (18%) in the placebo group (P<0.001); HRS reversal without renal-replacement therapy by day 30, in 68 (34%) and 17 (17%), respectively (P = 0.001); HRS reversal among patients with systemic inflammatory response syndrome (84 patients in the terlipressin group and 48 patients in the placebo group), in 31 (37%) and 3 (6%), respectively (P<0.001); and verified reversal of HRS without recurrence by day 30, in 52 (26%) and 17 (17%), respectively (P = 0.08). At day 90, liver transplantations had been performed in 46 patients (23%) in the terlipressin group and 29 patients (29%) in the placebo group, and death occurred in 101 (51%) and 45 (45%), respectively. More adverse events, including abdominal pain, nausea, diarrhea, and respiratory failure, occurred with terlipressin than with placebo. Death within 90 days due to respiratory disorders occurred in 22 patients (11%) in the terlipressin group and 2 patients (2%) in the placebo group. CONCLUSIONS: In this trial involving adults with cirrhosis and HRS-1, terlipressin was more effective than placebo in improving renal function but was associated with serious adverse events, including respiratory failure. (Funded by Mallinckrodt Pharmaceuticals; CONFIRM ClinicalTrials.gov number, NCT02770716.).


Assuntos
Síndrome Hepatorrenal/tratamento farmacológico , Terlipressina/uso terapêutico , Vasoconstritores/uso terapêutico , Albuminas/uso terapêutico , Terapia Combinada , Método Duplo-Cego , Feminino , Síndrome Hepatorrenal/etiologia , Síndrome Hepatorrenal/mortalidade , Humanos , Infusões Intravenosas , Cirrose Hepática/complicações , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Terapia de Substituição Renal , Insuficiência Respiratória/induzido quimicamente , Terlipressina/efeitos adversos , Resultado do Tratamento , Vasoconstritores/efeitos adversos
11.
South Med J ; 114(3): 180-185, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33655313

RESUMO

OBJECTIVES: The etiology of vasopressor-induced digital necrosis is poorly understood, but the skin changes resemble those of frostbite, and it is known from experience that patients taking vasopressors have decreased digital temperatures. We aimed to examine the effects of norepinephrine use on surface temperatures of the distal extremities because there have been no studies examining this relation. METHODS: Surface temperatures of all digits, palms, and soles were measured using an infrared thermometer in patients receiving different rates of norepinephrine infusion in the intensive care unit and compared with those not receiving any vasopressors. RESULTS: A total of 101 measurements from 41 unique individuals were obtained. Temperature gradients between the core and the fingertips were consistently more pronounced in those receiving norepinephrine compared with those not receiving norepinephrine and increased with increasing rates of norepinephrine infusion, except with high-dose norepinephrine. Temperature gradients were more pronounced in the toes. CONCLUSIONS: Norepinephrine use was associated with greater core-to-fingertip temperature gradients and were more pronounced in the toes compared with the fingers.


Assuntos
Norepinefrina/efeitos adversos , Temperatura Cutânea/efeitos dos fármacos , Vasoconstritores/efeitos adversos , Idoso , Estudos de Casos e Controles , Feminino , Dedos/fisiopatologia , Humanos , Unidades de Terapia Intensiva , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multinível , Dedos do Pé/fisiopatologia
12.
Trials ; 22(1): 208, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33712076

RESUMO

BACKGROUND: Arterial hypotension induced by general anesthesia is commonly identified as a risk factor of morbidity, especially neurological, after cardiac or noncardiac surgery in adults and children. Intraoperative hypotension is observed with sevoflurane anesthesia in children, in particular in neonates, infants younger than 6 months, and preterm babies. Ephedrine is commonly used to treat intraoperative hypotension. It is an attractive therapeutic, due to its dual action on receptors alpha and beta and its possible peripheral intravenous infusion. There are few data in the literature on the use of ephedrine in the context of pediatric anesthesia. The actual recommended dose of ephedrine (0.1 to 0.2 mg/Kg) frequently leads to a therapeutic failure in neonates and infants up to 6 months of age. The use of higher doses would probably lead to a better correction of hypotension in this population. The objective of our project is to determine the optimal dose of ephedrine for the treatment of hypotension after induction of general anesthesia with sevoflurane, in neonates and infants up to 6 months of age. METHODS: The ephedrine study is a prospective, randomized, open-label, controlled, dose-escalation trial. The dose escalation consists of 6 successive cohorts of 20 subjects. The doses studied are 0.6, 0.8, 1, 1.2, and 1.4 mg/kg. The dose chosen as the reference is 0.1 mg/kg, the actual recommended dose. Neonates and infants younger than 6 months, males and females, including preterm babies who undergo a surgery with general anesthesia inducted with sevoflurane were eligible. Parents of the subject were informed. Then, the subjects were randomized if presenting a decrease in mean blood pressure superior to 20% of their initial mean blood pressure (before induction of anesthesia), despite a vascular filling with sodium chloride 0.9%. The primary outcome is the success of the therapy defined as an mBP superior to 80% of the baseline mBP (prior to anesthesia) within 10 min post ephedrine administration. The subjects were followed-up for 3 days postanesthesia. DISCUSSION: This study is the first randomized, controlled trial intending to determine the optimal dose of ephedrine to treat hypotension in neonates and infants below 6 months old. TRIAL REGISTRATION: ClinicalTrials.gov NCT02384876 . Registered on March 2015.


Assuntos
Efedrina , Hipotensão , Adulto , Anestesia Geral/efeitos adversos , Pressão Sanguínea , Criança , Efedrina/efeitos adversos , Feminino , Humanos , Hipotensão/induzido quimicamente , Hipotensão/diagnóstico , Hipotensão/tratamento farmacológico , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Vasoconstritores/efeitos adversos
13.
Eur J Anaesthesiol ; 38(10): 1067-1076, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33625060

RESUMO

BACKGROUND: In Germany, hypotension induced by spinal anaesthesia is commonly treated with a combination of cafedrine hydrochloride (C, 200 mg) and theodrenaline hydrochloride (T, 10 mg) in 2 ml. We compared the effectiveness of C/T with ephedrine. OBJECTIVES: The primary objectives were to assess the speed of onset and the ability to restore blood pressure without an increase in heart rate. Secondary objectives were to evaluate maternal/foetal outcomes and the number of required additional boluses or other additional measures. DESIGN: HYPOTENS was a national, multicentre, prospective, open-label, two-armed, noninterventional study comparing C/T with ephedrine in two prospectively defined cohorts. This study relates to the cohort of patients receiving spinal anaesthesia for caesarean section. SETTING: German hospitals using either C/T or ephedrine in their routine clinical practice. PATIENTS: Women aged at least 18 years receiving spinal anaesthesia for caesarean section. INTERVENTIONS: Bolus administration of C/T or ephedrine at the discretion of the attending anaesthesiologist. MAIN OUTCOME MEASURES: Endpoints within 15 min after initial administration of C/T or ephedrine were area under the curve between the observed SBP and the minimum target SBP; and incidence of newly occurring heart rate of at least 100 beats min-1. RESULTS: Although effective blood pressure stabilisation was achieved with both treatments, this effect was faster and more pronounced with C/T (P < 0.0001). The incidence of tachycardia and changes in heart rate were higher with ephedrine (P < 0.01). Fewer additional boluses (P < 0.01) were required with C/T. Although favourable neonatal outcomes were reported in both groups, base deficit and lactate values were greater with ephedrine (P < 0.01). Physician satisfaction was higher with C/T. CONCLUSIONS: After C/T, tachycardia was not a problem, providing an advantage over ephedrine. Fewer additional boluses were required with C/T, suggesting greater effectiveness. An increased base deficit with ephedrine suggests reduced oxygen supply or increased demands in foetal circulation. TRIALS REGISTRATION: Clinicaltrials.gov: NCT02893241, German Clinical Trials Register: DRKS00010740.


Assuntos
Anestesia Obstétrica , Raquianestesia , Hipotensão Controlada , Hipotensão , Adolescente , Adulto , Anestesia Obstétrica/efeitos adversos , Raquianestesia/efeitos adversos , Cesárea , Efedrina , Feminino , Humanos , Hipotensão/induzido quimicamente , Hipotensão/diagnóstico , Hipotensão/tratamento farmacológico , Recém-Nascido , Norepinefrina/análogos & derivados , Fenilpropanolamina/análogos & derivados , Gravidez , Estudos Prospectivos , Teofilina/análogos & derivados , Vasoconstritores/efeitos adversos
14.
J Med Vasc ; 46(1): 13-21, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33546816

RESUMO

Acute limb ischemia induced by arterial vasospasm remains an exceptional situation, favoured by the use of arterial vasoconstrictors. The risk of these substances is largely underestimated in the general population, especially with the co-administration of strong cytochrome inhibitors like human immunodeficiency virus (HIV) protease inhibitors. A 33-year-old woman, who used to take dihydroergotamine for orthostatic hypotension, was prescribed a post-exposure HIV prophylaxis including lopinavir and ritonavir. One day later, she presented an acute bilateral limb ischemia with a sudden pain in both calves, initially while walking and then at rest with bilateral ischemic toes. Angiography confirmed diffuse arterial vasospasm of the lower limb arteries. A first-line therapy with isosorbide dinitrate and amlodipine was ineffective, with rapid clinical worsening. A combination of intra-arterial injections and intra-venous infusions of vasodilators, transluminal balloon angioplasty and bilateral 4-Compartment fasciotomies permitted rapid improvement and finally resulted in both lower limbs rescue. This case and literature review illustrate ergotism due to ergotamine overdose after taking HIV protease inhibitors. It also demonstrates the benefit of an interventional procedure besides medical therapy with vasodilators in severe arterial vasospasm. All along the lower limb arterial tree, transluminal balloon angioplasty restored the blood flow, without vasospasm recurrence. CONCLUSION: In case of ergotism with acute lower limbs ischemia, combining medical vasodilator therapy with interventional procedure can restore the arterial blood flow, thus allowing to save lower limbs.


Assuntos
Angioplastia com Balão , Di-Hidroergotamina/efeitos adversos , Ergotismo/etiologia , Inibidores da Protease de HIV/efeitos adversos , Isquemia/terapia , Vasoconstritores/efeitos adversos , Doença Aguda , Adulto , Ergotismo/diagnóstico , Ergotismo/fisiopatologia , Feminino , Infecções por HIV/prevenção & controle , Humanos , Isquemia/induzido quimicamente , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Extremidade Inferior/irrigação sanguínea , Fatores de Risco , Resultado do Tratamento
16.
Arch Dis Child Fetal Neonatal Ed ; 106(4): 446-455, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33478959

RESUMO

In persistent pulmonary hypertension of the newborn (PPHN), the ratio of pulmonary vascular resistance to systemic vascular resistance is increased. Extrapulmonary shunts (patent ductus arteriosus and patent foramen value) allow for right-to-left shunting and hypoxaemia. Systemic hypotension can occur in newborns with PPHN due to variety of reasons, such as enhanced peripheral vasodilation, impaired left ventricular function and decreased preload. Systemic hypotension can lead to end organ injury from poor perfusion and hypoxaemia in the newborn with PPHN. Thus, it must be managed swiftly. However, not all newborns with PPHN and systemic hypotension can be managed the same way. Individualised approach based on physiology and echocardiographic findings are necessary to improve perfusion to essential organs. Here we present a review of the physiology and mechanisms of systemic hypotension in PPHN, which can then guide treatment.


Assuntos
Hipotensão/epidemiologia , Hipotensão/terapia , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Vasoconstritores/uso terapêutico , Monitores de Pressão Arterial , Oxigenação por Membrana Extracorpórea/métodos , Hidratação/métodos , Hemodinâmica , Humanos , Hipotensão/fisiopatologia , Recém-Nascido , Síndrome da Persistência do Padrão de Circulação Fetal/fisiopatologia , Guias de Prática Clínica como Assunto , Vasoconstritores/administração & dosagem , Vasoconstritores/efeitos adversos
17.
J Crit Care ; 61: 1-4, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33049486

RESUMO

CONTEXT: Vasopressors are commonly administered through Central Venous Catheters (CVCs) as it is considered unsafe to administer them via peripheral IVs, mainly due to the concern of local tissue injury. Unlike peripheral IVs, midline catheters provide a wider lumen with the catheter tip ending in a large peripheral vein. The use of vasopressors through midline catheters has not yet been evaluated. OBJECTIVE: The primary objective of this study is to determine the safety and efficacy of long term administration of vasopressors through a midline catheter. DESIGN: This is a retrospective study between 2016 and 2019 looking at the outcomes of midline catheters. SETTING: 45 bed Tertiary level ICU in a 600-bed teaching hospital. PATIENTS: A total of 248 patients received vasopressors via midline catheters. RESULTS: The average midline dwell time was 14.7 ± 12.8 days and the average duration of continuous vasopressor infusion was 7.8 ± 9.3 days. Vasopressors used with their average dose (AD) were norepinephrine (n = 165, 16.8 CE ± 10.7 µg/min), epinephrine (n = 56, 9.1 CE ± 6.0 µg/min), vasopressin (n = 123, 0.05 CE ± 0.02 units/min), phenylephrine (n = 158, 91.4 CE ± 64.7 µg/min) and Angiotensin II (50 CE ± 27.6 ng/kg/min). Early Complication rate was 3.6% due to Bloodstream infection (n = 6), drug extravasation (n = 1), thrombophlebitis (n = 1) and arterial puncture (n = 1). Late Complication rate was 0.8% (n = 2) due to midline-associated DVTs. There were no complications related to ineffective drug delivery or limb endangerment. CONCLUSIONS: Many medical centers are attempting to limit the use of central venous catheters (CVCs) to avoid central line-associated bloodstream infections (CLABSIs). This study demonstrates that midline catheters are a safe alternative to CVCs, for the safe and efficacious administration of vasopressors for prolonged periods of time.


Assuntos
Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Cateterismo Periférico , Cateteres Venosos Centrais , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Humanos , Fenilefrina , Estudos Retrospectivos , Vasoconstritores/efeitos adversos
19.
J Crit Care ; 61: 133-137, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33160177

RESUMO

PURPOSE: Norepinephrine (NE) is recommended first-line for treatment of septic shock, partly due to its intrinsically low effect on heart rate. While dysrhythmias secondary to NE are still reported, factors associated with development of this adverse effect have not been described. Our study sought to investigate factors associated with dysrhythmias in patients receiving NE for septic shock. MATERIALS AND METHODS: We conducted a retrospective cohort study of adults receiving NE for septic shock if NE was initiated as the first vasopressor and continued for at least 6 h. The primary objective was to determine the rate of dysrhythmias among this patient population. Secondary objectives included determining the effect of dysrhythmia development on patient outcomes and elucidating predictors for dysrhythmia development. RESULTS: Of the 250 patients included, 34.4% (n = 86) developed a dysrhythmia. These patients had higher mortality (30.5% vs. 63.9%; p < 0.001) with decreased ICU-free days (2 vs. 4; p = 0.04) and ventilator-free days (7 vs. 4; p = 0.048). Duration of NE infusion and maximum NE dose were found to be independently associated with increased rates of dysrhythmia (p < 0.005). CONCLUSION: Development of dysrhythmia is associated with increased mortality and is independently associated with longer duration of NE infusion and higher NE doses.


Assuntos
Norepinefrina , Choque Séptico , Adulto , Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/tratamento farmacológico , Arritmias Cardíacas/epidemiologia , Humanos , Estudos Retrospectivos , Choque Séptico/tratamento farmacológico , Vasoconstritores/efeitos adversos
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