Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Department of Critical Care Medicine, Ground Floor, McCaig Tower, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada.
Crit Care. 2021 Apr 16;25(1):146. doi: 10.1186/s13054-021-03553-1.
It is unclear whether vasopressors can be safely administered through a peripheral intravenous (PIV). Systematic review and meta-analysis methodology was used to examine the incidence of local anatomic adverse events associated with PIV vasopressor administration in patients of any age cared for in any acute care environment.
MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of controlled trials, and the Database of Abstracts of Reviews of Effects were searched without restriction from inception to October 2019. References of included studies and related reviews, as well as relevant conference proceedings were also searched. Studies were included if they were: (1) cohort, quasi-experimental, or randomized controlled trial study design; (2) conducted in humans of any age or clinical setting; and (3) reported on local anatomic adverse events associated with PIV vasopressor administration. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials or the Joanna Briggs Institute checklist for prevalence studies where appropriate. Incidence estimates were pooled using random effects meta-analysis. Subgroup analyses were used to explore sources of heterogeneity.
Twenty-three studies were included in the systematic review, of which 16 and 7 described adults and children, respectively. Meta-analysis from 11 adult studies including 16,055 patients demonstrated a pooled incidence proportion of adverse events associated with PIV vasopressor administration as 1.8% (95% CI 0.1-4.8%, I = 93.7%). In children, meta-analysis from four studies and 388 patients demonstrated a pooled incidence proportion of adverse events as 3.3% (95% CI 0.0-10.1%, I = 82.4%). Subgroup analyses did not detect any statistically significant effects associated with stratification based on differences in clinical location, risk of bias or design between studies, PIV location and size, or vasopressor type or duration. Most studies had high or some concern for risk of bias.
The incidence of adverse events associated with PIV vasopressor administration is low. Additional research is required to examine the effects of PIV location and size, vasopressor type and dose, and patient characteristics on the safety of PIV vasopressor administration.
目前尚不清楚血管加压素是否可以通过外周静脉（PIV）安全给药。本系统评价和荟萃分析旨在研究任何年龄、任何急性护理环境下接受治疗的患者，通过 PIV 给予血管加压素与局部解剖不良事件相关的发生率。
检索 MEDLINE、EMBASE、CINAHL、Cochrane 对照试验中心注册库和效果摘要数据库，无时间限制，截至 2019 年 10 月。还搜索了纳入研究的参考文献和相关综述以及相关会议论文集。如果研究符合以下条件，则将其纳入：（1）队列、准实验或随机对照试验研究设计；（2）在任何年龄或临床环境下的人类中进行；（3）报告与 PIV 血管加压素给药相关的局部解剖不良事件。使用修订后的 Cochrane 随机试验偏倚风险工具或 Joanna Briggs 研究所适合的患病率研究清单评估偏倚风险。使用随机效应荟萃分析汇总发生率估计值。进行亚组分析以探索异质性来源。
本系统评价共纳入 23 项研究，其中 16 项和 7 项分别描述了成人和儿童。对 11 项成人研究（共纳入 16055 例患者）的荟萃分析显示，与 PIV 血管加压素给药相关的不良事件发生率为 1.8%（95%CI 0.1-4.8%，I=93.7%）。在儿童中，四项研究（共纳入 388 例患者）的荟萃分析显示，不良事件发生率为 3.3%（95%CI 0.0-10.1%，I=82.4%）。亚组分析未发现基于研究间临床地点、偏倚风险或设计、PIV 位置和大小、或血管加压素类型或持续时间的差异进行分层的任何统计学显著影响。大多数研究的偏倚风险为高或存在一定的关注。
与 PIV 血管加压素给药相关的不良事件发生率较低。需要进一步研究 PIV 位置和大小、血管加压素类型和剂量以及患者特征对 PIV 血管加压素给药安全性的影响。
