Delaney Anthony, Finnis Mark, Bellomo Rinaldo, Udy Andrew, Jones Daryl, Keijzers Gerben, MacDonald Stephen, Peake Sandra
Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Division of Critical Care, The George Institute for Global Health, Sydney, New South Wales, Australia.
Emerg Med Australas. 2020 Apr;32(2):210-219. doi: 10.1111/1742-6723.13394. Epub 2019 Oct 9.
To assess whether the initiation of vasopressor infusions via peripheral venous catheters (PVC) compared to central venous catheters (CVC) in ED patients with early septic shock was associated with differences in processes of care and outcomes.
We conducted a post-hoc analysis of the ARISE trial. We compared participants who had a vasopressor infusion first commenced via a PVC versus a CVC. The primary outcome was 90 day mortality.
We studied 937 participants. Of these, 389 (42%) had early vasopressor infusion commenced via a PVC and 548 (58%) via a CVC. Trial participants who received a vasopressor infusion via a PVC were more severely ill, with higher median (interquartile range [IQR]) Acute Physiology And Chronic Health Evaluation (APACHE II) scores (17 [13-23] versus 16 [12-21], P = 0.003), and higher median (IQR) lactate (mmol/L) (3.6 [1.9-5.8] versus 2.5 [1.5-4.5], P < 0.001). After adjusting for baseline covariates, the estimated odds ratio for mortality for PVC-treated patients was 1.26 (95% confidence interval 0.95-1.67, P = 0.11). Trial participants who had vasopressors commenced via PVC had a shorter median (IQR) time to commencement of antimicrobials (55 [32-96] versus 71.5 [39-119] min, P < 0.001) and a shorter median (IQR) time to commencement of vasopressors (2.4 [1.3-3.9] versus 4.9 [3.5-6.6] h, P < 0.001).
The practice of commencing a vasopressor infusion via a PVC was common in the ARISE trial and more frequent in trial participants with higher severity of illness. Commencement of a vasopressor infusion via a PVC was associated with some improvements in processes of care and, after adjustment, was not associated with an increased risk of death.
评估在急诊科早期感染性休克患者中，经外周静脉导管（PVC）输注血管活性药物与经中心静脉导管（CVC）输注相比，在护理过程和结局方面是否存在差异。
我们对ARISE试验进行了事后分析。比较了首次通过PVC与CVC开始输注血管活性药物的参与者。主要结局是90天死亡率。
我们研究了937名参与者。其中，389名（42%）通过PVC开始早期血管活性药物输注，548名（58%）通过CVC开始输注。通过PVC接受血管活性药物输注的试验参与者病情更严重，急性生理与慢性健康状况评估（APACHE II）评分中位数（四分位间距[IQR]）更高（17[13 - 23]对16[12 - 21]，P = 0.003），乳酸（mmol/L）中位数（IQR）更高（3.6[1.9 - 5.8]对2.5[1.5 - 4.5]，P < 0.001）。在对基线协变量进行调整后，接受PVC治疗患者的估计死亡比值比为1.26（95%置信区间0.95 - 1.67，P = 0.11）。通过PVC开始使用血管活性药物的试验参与者开始使用抗菌药物的中位时间（IQR）更短（55[32 - 96]分钟对71.5[39 - 119]分钟，P < 0.001），开始使用血管活性药物的中位时间（IQR）也更短（2.4[1.3 - 3.9]小时对4.9[3.5 - 6.6]小时，P < 0.001）。
在ARISE试验中，通过PVC开始输注血管活性药物的做法很常见，且在病情更严重的试验参与者中更频繁。通过PVC开始输注血管活性药物与护理过程的一些改善相关，调整后与死亡风险增加无关。
