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Am J Emerg Med. 2018 Dec 3. pii: S0735-6757(18)30963-X. doi: 10.1016/j.ajem.2018.12.001. [Epub ahead of print]

Push dose pressors: Experience in critically ill patients outside of the operating room.

Author information

1
Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 655, Rochester, NY 14642, United States of America.
2
Department of Pharmacy, University of Rochester Medical Center, 601 Elmwood Ave., Box 638, Rochester, NY 14642, United States of America.
3
Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 655, Rochester, NY 14642, United States of America; Department of Pulmonary Diseases and Critical Care, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, United States of America.
4
Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 655, Rochester, NY 14642, United States of America; Department of Pharmacy, University of Rochester Medical Center, 601 Elmwood Ave., Box 638, Rochester, NY 14642, United States of America. Electronic address: nicole_acquisto@urmc.rochester.edu.

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 ± 13.3 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 106 mmHg), 27.2% (48 to 61 mmHg), and 6.4% (93 to 99 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 μg or ephedrine dose >25 mg), nine (6.2%) received PDP with normal/elevated hemodynamics (systolic BP > 100 mmHg or HR > 160 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.

KEYWORDS:

Critical care; Hypotension; Phenylephrine; Push dose pressors; Vasopressor

PMID:
30553634
DOI:
10.1016/j.ajem.2018.12.001

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