Patel Vishal V, Sullivan Jesse B, Cavanaugh Joseph
518097Idaho College of Osteopathic Medical School, Meridian, ID, USA.
Community Medical Center, Toms River, NJ, USA.
J Pharm Pract. 2023 Feb;36(1):15-18. doi: 10.1177/08971900211000218. Epub 2021 Mar 23.
Phenylephrine is a selective α-receptor agonist used to manage shock. Current guidelines for septic shock recommend limited utilization of phenylephrine due to the lack of evidence available. This deviates from previous guidelines, which had recommendations of when utilization may be appropriate.
The primary objective of this study was to evaluate mortality in patients receiving phenylephrine for the management of septic shock.
This was a retrospective chart review from September 2015 to September 2017 evaluating all adult patients admitted to an intensive care unit (ICU) on vasopressors for management of septic shock. Patients were divided into 2 groups, those treated with phenylephrine and those treated without phenylephrine. The primary outcome was mortality. Secondary objectives included days on vasopressors and ICU length of stay. Two subgroup analyses were performed: 1 for phenylephrine as first-line therapy and 1 for patients with tachycardia at initiation of vasopressors. Patients started on phenylephrine for salvage therapy were excluded from this study.
499 patients enrolled in the study. 148 (32%) were enrolled in the phenylephrine group. Phenylephrine was associated with an increase in mortality (56% vs 41%; p = 0.003). There was no difference in the days on vasopressors or ICU length of stay. Patients who had ongoing tachycardia were associated with increased mortality with phenylephrine (54% vs 36%, p = 0.02). There was no difference in mortality when phenylephrine was started as the initial vasopressor.
Utilization of phenylephrine in septic shock patients, especially those with ongoing tachycardia, was associated with an increased rate of mortality.
去氧肾上腺素是一种用于治疗休克的选择性α受体激动剂。由于缺乏可用证据，目前脓毒症休克指南建议有限使用去氧肾上腺素。这与之前有何时使用可能合适的建议的指南不同。
本研究的主要目的是评估接受去氧肾上腺素治疗脓毒症休克患者的死亡率。
这是一项回顾性图表审查，时间跨度为2015年9月至2017年9月，评估所有入住重症监护病房（ICU）并使用血管升压药治疗脓毒症休克的成年患者。患者分为两组，一组接受去氧肾上腺素治疗，另一组未接受去氧肾上腺素治疗。主要结局是死亡率。次要目标包括使用血管升压药的天数和ICU住院时间。进行了两项亚组分析：一项是将去氧肾上腺素作为一线治疗，另一项是针对血管升压药起始时心动过速的患者。开始使用去氧肾上腺素进行挽救治疗的患者被排除在本研究之外。
499名患者纳入研究。148名（32%）患者纳入去氧肾上腺素组。去氧肾上腺素与死亡率增加相关（56%对41%；p = 0.003）。使用血管升压药的天数或ICU住院时间没有差异。持续心动过速的患者使用去氧肾上腺素时死亡率增加（54%对36%，p = 0.02）。当去氧肾上腺素作为初始血管升压药开始使用时，死亡率没有差异。
在脓毒症休克患者中使用去氧肾上腺素，尤其是那些持续心动过速的患者，与死亡率增加相关。
