Department of Emergency Medicine, Hennepin Healthcare, 701 Park Ave, Mail Code RL.240, Minneapolis, MN, 55415, USA.
Duke University School of Medicine, Durham, NC, USA.
J Med Toxicol. 2019 Oct;15(4):276-286. doi: 10.1007/s13181-019-00716-z. Epub 2019 Jul 3.
Though the use of small bolus doses of vasopressors, termed "push dose pressors," has become common in emergency medicine, data examining this practice are scant. Push dose pressors frequently involve bedside dilution, which may result in errors and adverse events. The objective of this study was to assess for instances of human error and adverse hemodynamic events during push dose pressor use in the emergency department.
This was a structured chart and video review of all patients age ≥ 16 years undergoing resuscitation and receiving push dose pressors from a single center from January 2010 to November 2017. Push dose pressors were defined as intended intravenous boluses of phenylephrine (any dose) or epinephrine (≤ 100 mcg).
A total of 249 patients were analyzed. Median age was 60 years (range, 16-97), 58% were male, 49% survived to discharge. Median initial epinephrine dose was 20 mcg (n = 139, IQR 10-100, range 1-100); median phenylephrine dose was 100 mcg (n = 110, IQR 100-100, range 25-10,000). Adverse hemodynamic events occurred in 98 patients (39%); 30 in the phenylephrine group (27%; 95% CI, 19-36%), and 68 in the epinephrine group (50%; 95% CI, 41-58%). Human errors were observed in 47 patients (19%), including 7 patients (3%) experiencing dosing errors (all overdoses; range, 2.5- to 100-fold) and 43 patients (17%) with a documentation error. Only one dosing error occurred when a pharmacist was present.
Human errors and adverse hemodynamic events were common with the use of push dose pressors in the emergency department. Adverse hemodynamic events were more common than in previous studies. Future research should determine if push dose pressors improve outcomes and if so, how to safely implement them into practice.
尽管在急诊医学中使用小剂量血管加压药（称为“推注剂量加压药”）已变得很常见，但有关这种做法的数据却很少。推注剂量加压药经常涉及床边稀释，这可能导致错误和不良事件。本研究的目的是评估在急诊科使用推注剂量加压药时发生人为错误和不良血流动力学事件的情况。
这是对 2010 年 1 月至 2017 年 11 月期间，来自单个中心的所有接受复苏并接受推注剂量加压药的年龄≥16 岁的患者进行的结构化图表和视频回顾。推注剂量加压药被定义为有意给予苯肾上腺素（任何剂量）或肾上腺素（≤100mcg）的静脉推注。
共分析了 249 名患者。中位年龄为 60 岁（范围 16-97），58%为男性，49%存活至出院。中位初始肾上腺素剂量为 20mcg（n=139，IQR 10-100，范围 1-100）；中位苯肾上腺素剂量为 100mcg（n=110，IQR 100-100，范围 25-10000）。98 名患者（39%）发生不良血流动力学事件；苯肾上腺素组 30 例（27%；95%CI，19-36%），肾上腺素组 68 例（50%；95%CI，41-58%）。在 47 名患者（19%）中观察到人为错误，包括 7 名（3%）患者出现剂量错误（均为用药过量；范围为 2.5-100 倍）和 43 名（17%）患者存在记录错误。只有一名药剂师在场时发生了一次剂量错误。
在急诊科使用推注剂量加压药时，人为错误和不良血流动力学事件很常见。不良血流动力学事件比以前的研究更为常见。未来的研究应确定推注剂量加压药是否改善了结果，如果是，如何安全地将其实施到实践中。
