Cour Martin, Bénet Thomas, Hernu Romain, Simon Marie, Baudry Thomas, Vanhems Philippe, Argaud Laurent
Service de Réanimation Médicale, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France.
Faculté de médecine Lyon-Est, Université Lyon 1, Université de Lyon, 69008, Lyon, France.
Ann Intensive Care. 2016 Dec;6(1):38. doi: 10.1186/s13613-016-0139-3. Epub 2016 Apr 22.
Changeovers of norepinephrine infusion pumps (CNIPs) frequently lead to haemodynamic instability. The aim of this study was to identify risk factors for haemodynamic instability associated with CNIP, independent of the method used to perform the relay.
We performed a prospective study, in a university-affiliated intensive care unit. Over a 1-year period, all adult patients who had at least one CNIP were included. CNIPs were automatically performed using smart pumps, in accordance with a standardised protocol. CNIP-induced haemodynamic instability was defined as a variation in mean arterial pressure (MAP) >25 %. A multivariate mixed effects logistic regression was fitted to assess the factors associated with CNIP-induced haemodynamic instability.
From the 118 patients included in the study, 764 CNIPs were analysed. Most of the patients were treated with norepinephrine for septic shock of medical origin (n = 83, 70 %). Haemodynamic instability occurred 114 times (15 %) in 63 patients (53 %). Among the risk factors identified by the univariate analysis (age, heart rate, dose of norepinephrine infused, and change in the concentration of the vasoactive drug; p < 0.05), change in the norepinephrine concentration was the only independent risk factor for CNIP-induced haemodynamic instability identified in the multivariate analysis (adjusted OR 11.8, 95 % CI 7.2-19.5, p < 0.001).
Changes in the norepinephrine concentration during CNIPs lead to a high risk of haemodynamic instability, while the clinical severity of patients, as well as the doses of norepinephrine, was not.
去甲肾上腺素输注泵的更换（CNIP）常常导致血流动力学不稳定。本研究的目的是确定与CNIP相关的血流动力学不稳定的危险因素，而不考虑进行接力的方法。
我们在一所大学附属医院的重症监护病房进行了一项前瞻性研究。在1年的时间里，纳入了所有至少有一次CNIP的成年患者。CNIP根据标准化方案使用智能泵自动进行。CNIP引起的血流动力学不稳定定义为平均动脉压（MAP）变化>25%。采用多变量混合效应逻辑回归来评估与CNIP引起的血流动力学不稳定相关的因素。
在纳入研究的118例患者中，分析了764次CNIP。大多数患者因医源性感染性休克接受去甲肾上腺素治疗（n = 83，70%）。63例患者（53%）发生血流动力学不稳定114次（15%）。在单变量分析确定的危险因素（年龄、心率、输注的去甲肾上腺素剂量以及血管活性药物浓度的变化；p < 0.05）中，去甲肾上腺素浓度的变化是多变量分析中确定的与CNIP引起的血流动力学不稳定唯一相关的独立危险因素（校正OR 11.8，95%CI 7.2 - 19.5，p < 0.001）。
CNIP期间去甲肾上腺素浓度的变化会导致血流动力学不稳定的高风险，而患者的临床严重程度以及去甲肾上腺素的剂量则不然。
