Nam Elizabeth, Fitter Scott, Moussavi Kayvan
Clinical Pharmacist, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354, USA.
Clinical Pharmacy Specialist - Emergency Medicine, Loma Linda University Medical Center, Loma Linda University School of Pharmacy, 24745 Stewart St. Shryock Hall, Loma Linda, CA 92350, USA.
Am J Emerg Med. 2022 Feb;52:43-49. doi: 10.1016/j.ajem.2021.11.033. Epub 2021 Nov 25.
There is limited evidence to support the efficacy and safety of push-dose vasopressor (PDP) use outside of the operating room (OR). Specifically, there are few head-to-head comparisons of different PDP in these settings. The purpose of this study was to compare the efficacy and safety of push-dose phenylephrine (PDP-PE) and epinephrine (PDP-E) in the Emergency Department (ED).
This retrospective, single-center study evaluated adults given PDP-PE or PDP-E in the ED from May 2017 to November 2020. The primary outcome was a change in heart rate (HR). Secondary outcomes included changes in blood pressure, adverse effects, dosing errors, fluid and vasopressor requirements, ICU and hospital lengths of stay (LOS), and in-hospital mortality.
Ninety-six patients were included in the PDP-PE group and 39 patients in the PDP-E group. Median changes in HR were 0 [-7, 6] and - 2 [-15, 5] beats per minute (BPM) for PDP-PE and PDP-E, respectively (p = 0.138). PDP-E patients had a greater median increase in systolic blood pressure (SBP) (33 [24, 53] vs. 26 [8, 51] mmHg; p = 0.049). Dosing errors occurred more frequently in patients that received PDP-E (5/39 [12.8%] vs. 2/96 [2.1%]; p = 0.021). PDP-E patients more frequently received continuous epinephrine infusions before and after receiving PDP-E. There were no differences in adverse effects, fluid requirements, LOS, or mortality.
PDP-E provided a greater increase in SBP compared to PDP-PE. However, dosing errors occurred more frequently in those receiving PDP-E. Larger head-to-head studies are necessary to further evaluate the efficacy and safety of PDP-E and PDP-PE.
在手术室（OR）之外使用推注剂量血管升压药（PDP）的有效性和安全性的证据有限。具体而言，在这些情况下，不同PDP之间的直接比较很少。本研究的目的是比较急诊科（ED）中推注剂量去氧肾上腺素（PDP-PE）和肾上腺素（PDP-E）的有效性和安全性。
这项回顾性单中心研究评估了2017年5月至2020年11月在急诊科接受PDP-PE或PDP-E治疗的成年人。主要结局是心率（HR）的变化。次要结局包括血压变化、不良反应、给药错误、液体和血管升压药需求、重症监护病房（ICU）和住院时间（LOS）以及院内死亡率。
PDP-PE组纳入96例患者，PDP-E组纳入39例患者。PDP-PE和PDP-E的HR中位数变化分别为0[-7,6]和-2[-15,5]次/分钟（BPM）（p=0.138）。PDP-E患者的收缩压（SBP）中位数升高幅度更大（33[24,53]mmHg对26[8,51]mmHg；p=0.049）。接受PDP-E的患者给药错误更频繁（5/39[12.8%]对2/96[2.
