The impact of push-dose phenylephrine use on subsequent preload expansion in the ED setting
The impact of push-dose phenylephrine use on subsequent preload expansion in the ED setting
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DOI：
10.1016/j.ajem.2016.09.041
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发表时间：
2016-12-01
影响因子：
3.6
通讯作者：
Aaronson, Patrick M.
中科院分区：
文献类型：
--
作者：
Schwartz, Madison B.;Ferreira, Jason A.;Aaronson, Patrick M.
背景资料：大剂量苯肾上腺素（PHE）的利用已经过渡到急诊科（艾德）治疗急性水肿patients，尽管缺乏文献在此setting.Methods：这是一个单中心的回顾性图表审查大剂量苯肾上腺素的利用急性低血压的艾德在学术非营利医院。本研究的主要目的是报告首次推注剂量PHE后30分钟内开始连续血管加压药输注（CVI）的患者频率。次要目的包括观察性描述早期预负荷扩张（液体）对在艾德中大剂量PHE设置中启动CVI的影响。结果：73例患者符合纳入标准进行分析。主要结局，46.5%（n = 34）的患者在推注剂量PHE后30分钟内开始CVI。发现初始前负荷扩张（30 mL/kg IV液体）显著不成比例，34.2%适当液体挑战vs 65.8%（P= 0.0048）。此外，在充分IVF激发组中，需要显著减少PHE推注给药次数[1.5 vs 2.3（P=.01）]。对于次要终点，PHE最常用于插管周围低血压（n = 52，71.2%）。记录了15例（20.5%）患者的重大不良事件，心动过缓（n = 7; 9.6%）作为最常见的不良事件。结论：初步预载IVF扩张被认为是显着不成比例的，似乎与我们的研究人群中苯肾上腺素丸剂量的增加。(C)2016 Elsevier Inc. All rights reserved.
Background: The utilization of bolus-dose phenylephrine (PHE) has transitioned to the emergency department (ED) for the treatment of acutely hypotensive patients, despite a paucity of literature in this setting.Methods: This was a single center retrospective chart review of the utilization of bolus-dosed PHE for acute hypotension in the ED at an academic non-for profit hospital. The primary objective of this study is to report the frequency of patients that were initiated on a continuous vasopressor infusion (CVI) within 30 minutes after the first administration of bolus-dose PHE. Secondary objectives included an observational description of the impact of early preload expansion (fluids) on the initiation of CVIs in the setting of bolus-dose PHE in the ED.Results: Seventy-three patients met inclusion criteria for analysis. The primary outcome, 46.5% (n = 34) of patients were initiated on a CVI within 30 minutes following bolus-dose PHE. Initial preload expansion (30 mL/kg of IV fluids) was found to be significantly disproportionate with 34.2% appropriately fluid challenged vs 65.8% (P=.0048). In addition, a significant decrease in the number of PHE bolus doses were required [1.5 vs 2.3 (P=.01)] in the adequately IVF challenged group. For secondary endpoints, PHE was most commonly indicated for peri-intubation hypotension (n = 52, 71.2%). Significant adverse events were documented for 15 (20.5%) patients, with bradycardia (n = 7; 9.6%) as the most common adverse event.Conclusions: Initial preload IVF expansion was found to be significantly disproportionate, and appears to be associated with an increase number of phenylephrine bolus doses in our study population. (C) 2016 Elsevier Inc. All rights reserved.