McPherson Kaitlyn L, Kovacic Scherrer Nicole L, Hays William B, Greco Alexandra R, Garavaglia Jeffrey M
Emergency Medicine Pharmacist, Department of Pharmacy, Charleston Area Medical Center General Hospital, Charleston, WV, USA.
Medical Intensive Care Pharmacist, Department of Pharmacy, WVU Medicine, Morgantown, WV, USA.
J Pharm Pract. 2023 Aug;36(4):925-932. doi: 10.1177/08971900221096967. Epub 2022 Apr 22.
During hospitalization, the risk of hypotension and associated sequelae remain important considerations for patient outcomes. The use of push-dose vasopressors (PDP) outside of the operating room has increased in recent years to combat the negative effects of hypotension. This narrative review evaluates the utility of PDP in its traditional perioperative setting as well as in areas of increasing use such as the emergency department and intensive care unit. Articles evaluating PDP highlight successful increases in blood pressure with all agents but differ in rates of adverse events and most lack direct comparison of PDP agents in regard to safety and efficacy. Agents utilized as PDP, including epinephrine, phenylephrine, norepinephrine, vasopressin, and ephedrine vary in mechanism of action, onset of action, and duration of action. These variations in pharmacology along with published literature may lead to differences in the preferred PDP for various clinical scenarios. Many adverse events associated with PDP have been due to dosing errors highlighting the importance of education surrounding the use of these agents. Additional research is necessary to further elucidate the risks and benefits of PDP in clinical practice, and to determine which PDP is truly preferred. Careful consideration should be given when determining the appropriateness of this administration method of vasopressors in various clinical scenarios.
住院期间，低血压风险及相关后遗症仍是影响患者预后的重要因素。近年来，手术室之外使用推注式血管升压药（PDP）以对抗低血压负面影响的情况有所增加。本叙述性综述评估了PDP在传统围手术期环境以及急诊科和重症监护病房等使用日益增多领域的效用。评估PDP的文章均强调所有药物均可成功升高血压，但不良事件发生率有所不同，且大多数缺乏PDP药物在安全性和疗效方面的直接比较。用作PDP的药物，包括肾上腺素、去氧肾上腺素、去甲肾上腺素、血管加压素和麻黄碱，其作用机制、起效时间和作用持续时间各不相同。药理学上的这些差异以及已发表的文献可能导致在各种临床场景中首选的PDP有所不同。许多与PDP相关的不良事件是由给药错误引起的，这凸显了围绕这些药物使用进行教育的重要性。有必要进行更多研究以进一步阐明PDP在临床实践中的风险和益处，并确定哪种PDP是真正首选的。在确定这种血管升压药给药方法在各种临床场景中的适用性时，应予以仔细考虑。
