Department of Medicine, New York Presbyterian Queens, Flushing, NY, USA.
Department of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California San Diego, San Diego, CA, USA.
J Vasc Access. 2024 Jan;25(1):218-224. doi: 10.1177/11297298221105323. Epub 2022 Jun 10.
Peripherally inserted central catheters (PICCs) are increasingly recognized as an alternative to centrally inserted central catheters (CICCs) in critical care, yet the data regarding the safety and feasibility of this choice in septic shock management is growing but still lacking. In this study, we aimed to determine the feasibility, safety, and impact on outcomes of using dedicated vascular access specialist (VAS) teams to insert PICCs versus CICCs on patients admitted to the ICU with septic shock.
Retrospective cohort study.
Mayo Clinic Rochester Medical ICU and Mayo Clinic Arizona Multidisciplinary ICU from 2013 to 2016.
All adult patients hospitalized with diagnosis of septic shock excluding patients who declined authorization for review of their medical records, mixed shock states, and readmissions.
None.
Comprehensive data regarding septic shock diagnosis and resuscitation were abstracted from electronic medical records. A total of 562 patients with septic shock were included in the study; 215 patients were resuscitated utilizing a PICC and 347 were resuscitated using a CICC. On univariate analysis, the time to central line insertion and time to vasopressor initiation were found to be reduced in those who received PICC at time of ICU admission versus CICC. Other favorable outcomes were also observed in those who received PICC versus CICC including shorter ICU length of stay and lower unadjusted hospital mortality. A multivariable analysis for hospital mortality showed that after adjusting for important covariates, neither the time to central line insertion nor the time to vasopressor initiation was associated with a lower hospital mortality.
Across two tertiary referral centers within the same enterprise, use of a dedicated VAS team for insertion of PICCs for initial resuscitation in patients with septic shock was feasible and associated with shorter time to central venous access and initiation of vasopressors; however, adjusted hospital mortality was not different between the two groups.
外周置入中心静脉导管（PICC）在重症监护中越来越被认为是中心静脉置管（CICC）的替代选择，但在脓毒症休克管理中选择这种导管的安全性和可行性的数据在不断增加，但仍然不足。在这项研究中，我们旨在确定使用专门的血管通路专家（VAS）团队为入住 ICU 伴有脓毒症休克的患者插入 PICC 与 CICC 的可行性、安全性以及对结局的影响。
回顾性队列研究。
2013 年至 2016 年，Mayo 诊所罗切斯特医疗 ICU 和 Mayo 诊所亚利桑那多学科 ICU。
所有因诊断为脓毒症休克而住院的成年患者，不包括拒绝授权审查其病历、混合性休克状态和再次入院的患者。
无。
从电子病历中提取关于脓毒症休克诊断和复苏的综合数据。共有 562 例脓毒症休克患者纳入研究；215 例患者在 ICU 入院时使用 PICC 进行复苏，347 例患者使用 CICC 进行复苏。单变量分析发现，与接受 CICC 复苏的患者相比，在 ICU 入院时接受 PICC 复苏的患者的中心静脉置管时间和血管加压素起始时间更短。与接受 CICC 复苏的患者相比，接受 PICC 复苏的患者还观察到其他有利的结局，包括 ICU 住院时间更短和未调整的医院死亡率更低。多变量分析显示，在校正重要协变量后，中心静脉置管时间和血管加压素起始时间均与较低的医院死亡率无关。
在同一家企业的两个三级转诊中心，使用专门的 VAS 团队为脓毒症休克患者进行初始复苏时插入 PICC 是可行的，并且与中心静脉通路的建立和血管加压素的启动时间更短有关；然而，两组的调整后医院死亡率并无差异。
