School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Eur J Hosp Pharm. 2023 Jul;30(4):214-220. doi: 10.1136/ejhpharm-2021-003035. Epub 2021 Oct 7.
There is limited evidence to support metaraminol use in critically ill patients. Metaraminol is not included as a vasopressor choice in international guidelines for the management of shock. Nevertheless, metaraminol is used in rates up to 42% in this patient population. The objective of this study was to investigate the effectiveness of metaraminol for the treatment of critically ill patients with shock.
A single-centre retrospective matched observational study was conducted in a 54-bed intensive care unit of a tertiary hospital. Patients aged 16 years or older who were admitted from 2017 to 2019 with shock were included. Patients treated with metaraminol and norepinephrine (MET-NOR) were compared with those treated with norepinephrine without metaraminol (NOR). The primary outcome was the time to resolution of shock defined as the time to cessation of vasopressors. The secondary outcome was vasopressor-free days until 28 days.
There were 286 patients included in this study, including 143 patients in each group. The median time to resolution of shock was 44 hours (IQR 28-66 hours) in the MET-NOR group compared with 27 hours (IQR 14-63 hours) in the NOR group (95% CI of median difference 7 to 19 hours; p<0.01). The Cox regression analysis for the time to resolution of shock showed no significant difference between groups (HR 1.24, 95% CI 0.96 to 1.60; p=0.10). However, the proportional hazards assumption was not met (p<0.01). The median number of vasopressor-free days until 28 days was 26 days (IQR 24-27 days) in the MET-NOR group compared with 27 days (IQR 25-27 days) in the NOR group (95% CI of median difference -0.8 to -0.1 day; p<0.01).
In critically ill patients, metaraminol may be associated with a longer time to resolution of shock compared with those who do not receive metaraminol.
现有证据对去甲肾上腺素之外的血管加压药物在危重症患者中的应用支持有限。去甲肾上腺素以外的血管加压药物在国际休克管理指南中并未被列为休克的治疗选择。然而，在该患者人群中，去甲肾上腺素以外的血管加压药物使用率高达 42%。本研究旨在探讨去氧肾上腺素治疗休克危重症患者的有效性。
这是一项在一家三级医院 54 张病床的重症监护病房进行的单中心回顾性匹配观察性研究。纳入 2017 年至 2019 年因休克入住的年龄≥16 岁的患者。将接受去氧肾上腺素和去甲肾上腺素（MET-NOR）治疗的患者与未接受去氧肾上腺素治疗的去甲肾上腺素（NOR）治疗的患者进行比较。主要结局是休克缓解时间，定义为停止血管加压药物的时间。次要结局是直至第 28 天无血管加压药物天数。
这项研究共纳入 286 例患者，每组 143 例。在 MET-NOR 组，休克缓解的中位时间为 44 小时（IQR 28-66 小时），而在 NOR 组为 27 小时（IQR 14-63 小时）（95%CI 中位数差值为 7 至 19 小时；p<0.01）。对休克缓解时间的 Cox 回归分析显示，两组之间无显著差异（HR 1.24，95%CI 0.96 至 1.60；p=0.10）。然而，比例风险假设不成立（p<0.01）。直至第 28 天无血管加压药物天数的中位值在 MET-NOR 组为 26 天（IQR 24-27 天），在 NOR 组为 27 天（IQR 25-27 天）（95%CI 中位数差值为-0.8 至-0.1 天；p<0.01）。
在危重症患者中，与未接受去氧肾上腺素治疗的患者相比，去氧肾上腺素可能与缓解休克的时间更长有关。
