1 Department of Anesthesiology, Section of Critical Care, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
2 Department of Neurology, Section on Neurocritical Care, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
J Intensive Care Med. 2018 Oct;33(10):589-592. doi: 10.1177/0885066617712214. Epub 2017 Jun 1.
The traditional approach for infusing vasopressors is to insert central venous catheters, which is associated with several complications. Phenylephrine is a commonly used vasopressor in the neurologic intensive care unit (neuro ICU), and due to its modest potency, the risk of local tissue injury from extravasation may be overestimated. The purpose of this study was to evaluate the safety of phenylephrine infusion through peripheral intravenous catheter (PIV) in the neuro ICU.
Retrospective review of all consecutive adults admitted to the neuro ICU receiving phenylephrine infusion via PIV at a tertiary academic medical center from September 2012 to November 2015.
Two hundred seventy-seven patients with a mean age of 65 years (standard deviation [SD]: ±15) were included in the final analysis. The most common indications for phenylephrine use were hemodynamic augmentation (40%) and postoperative hypotension (32%). The most common location of PIV-infusing phenylephrine was proximal upper extremity (50%). The most common PIV gauge was 20 (41%). The mean maximum dose of phenylephrine was 79 μg/min (SD: ±53, range: 5-200) or 1.04 μg/kg/min (SD: ±0.74, range: 0.07-3.49) and was continued for a mean duration of 19 hours (SD: ±18, range: 1-129). Nine (3%) total episodes of PIV infiltration were noted, none requiring intervention for significant tissue injury or limb ischemia.
Infusion of phenylephrine through PIV is safe when used in moderate doses for a short time and can be considered in lieu of placing a central line solely for this purpose.
传统的升压药物输注方法是插入中心静脉导管，但这种方法会带来多种并发症。去氧肾上腺素是神经重症监护病房（neuro ICU）中常用的升压药物，由于其效力适中，血管外渗漏导致局部组织损伤的风险可能被高估。本研究旨在评估去氧肾上腺素通过外周静脉导管（PIV）输注在神经重症监护病房中的安全性。
回顾性分析 2012 年 9 月至 2015 年 11 月期间，在一家三级学术医疗中心，通过 PIV 输注去氧肾上腺素的所有连续成年神经重症监护病房患者。
最终分析纳入了 277 名平均年龄为 65 岁（标准差[SD]：±15）的患者。去氧肾上腺素使用的最常见指征是血流动力学增强（40%）和术后低血压（32%）。PIV 输注去氧肾上腺素最常见的部位是上肢近端（50%）。最常见的 PIV 管规为 20 号（41%）。去氧肾上腺素的平均最大剂量为 79μg/min（SD：±53，范围：5-200）或 1.04μg/kg/min（SD：±0.74，范围：0.07-3.49），输注时间平均为 19 小时（SD：±18，范围：1-129）。共观察到 9 例（3%）PIV 渗漏事件，均未因显著组织损伤或肢体缺血而需要干预。
在短时间内以中等剂量输注去氧肾上腺素是安全的，在某些情况下，可以考虑替代中心静脉置管，而无需仅仅为了这个目的而放置中心静脉导管。
