Department of Anesthesiology, Osaka Prefectural Hospital Organization, Osaka Women's and Children's Hospital, Osaka, Japan.
Department of Pediatrics, St. Marianna University, School of Medicine, Kawasaki, Japan; Department of Anesthesia and YCU Centre of Novel Exploratory Clinical Trials, Yokohama City University, Yokohama, Japan; CHU Sainte Justine Research Centre, University of Montreal, Montreal, Quebec, Canada.
J Cardiothorac Vasc Anesth. 2024 Dec;38(12):3215-3223. doi: 10.1053/j.jvca.2024.08.020. Epub 2024 Aug 13.
Prior meta-analysis suggested a low incidence of local adverse events after infusion of vasoactive agents via a peripheral venous catheter in children. However, the number of included patients was relatively low, and the vasoactive agents used were mostly dopamine. We performed an updated systematic review with meta-analysis using databases of MEDLINE (via PubMed) and Cochrane Central Register of Controlled Trials to explore the safety of infusing vasoactive agents, including epinephrine and norepinephrine, through peripheral venous catheters or intraosseous access in critically ill children. The primary outcome was the occurrence of local adverse events associated with peripheral vasoactive infusion, such as extravasation or infiltration. Twelve observational studies and 1 randomized controlled trial were finally included. The pooled incidence rates of local adverse events associated with infusion of vasoactive agents through peripheral venous catheters or intraosseous access, peripheral venous catheters only, and intraosseous access only were 2.1% (95% confidence interval [CI]: 0.8%-3.9%), 2.3% (95% CI: 1.0%-4.0%), and 1.1% (95% CI: 0.0%-9.8%), respectively. Based on the findings of this meta-analysis, the incidence rate of local adverse events associated with peripheral vasoactive infusion appears to be low. Peripheral infusion of vasoactive agents, including epinephrine and norepinephrine, can be considered when necessary.
先前的荟萃分析表明，在儿童外周静脉导管中输注血管活性药物后，局部不良事件的发生率较低。然而，纳入的患者数量相对较少，且使用的血管活性药物主要是多巴胺。我们使用 MEDLINE（通过 PubMed）和 Cochrane 对照试验中心注册数据库进行了更新的系统评价和荟萃分析，以探讨在危重病儿童中通过外周静脉导管或骨髓腔内通路输注血管活性药物（包括肾上腺素和去甲肾上腺素）的安全性。主要结局是与外周血管活性输注相关的局部不良事件的发生，如外渗或渗透。最终纳入了 12 项观察性研究和 1 项随机对照试验。通过外周静脉导管或骨髓腔内通路、仅外周静脉导管和仅骨髓腔内通路输注血管活性药物相关的局部不良事件的累积发生率分别为 2.1%（95%置信区间[CI]：0.8%-3.9%）、2.3%（95%CI：1.0%-4.0%）和 1.1%（95%CI：0.0%-9.8%）。基于这项荟萃分析的结果，与外周血管活性输注相关的局部不良事件发生率似乎较低。在必要时，可以考虑外周输注血管活性药物，包括肾上腺素和去甲肾上腺素。
