Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Air Med J. 2024 Sep-Oct;43(5):412-415. doi: 10.1016/j.amj.2024.05.008. Epub 2024 Jun 19.
Push-dose vasopressors are commonly administered to attenuate peri-intubation hypotension. The aim of this study was to describe the current use of push-dose vasopressors in critical care transport.
This was a retrospective chart review of adult patients (≥ 18 years) intubated between January 2017 and May 2023 who received push-dose vasopressors. The outcomes were incidence of push-dose vasopressor administration and the frequency of initiation or an increase in continuous vasopressor infusion.
Of the 334 patients intubated during this period, 49 (14.7%) received push-dose vasopressors in the peri-intubation period. The mean preintubation shock index was 1.1 ± 0.5. Of those who received push-dose vasopressors, 34 (69.4%) received multiple push doses; the mean number of administrations was 2.5 ± 1.9. Most patients had persistent or recurrent hypotension (n = 39, 79.6%). Fifteen (30.6%) were started on a continuous vasopressor infusion, and 3 (11.1%) had an increase in an existing infusion postintubation.
Although push-dose vasopressors are convenient and appropriate in many settings, they inadequately address hypotension in critically ill patients with underlying shock. Further investigation is required to better elucidate the role of peri-intubation push-dose and continuous vasopressors in the critical care transport setting.
推注血管加压素常用于减轻气管插管期间的低血压。本研究旨在描述在重症监护转运中使用推注血管加压素的情况。
这是一项对 2017 年 1 月至 2023 年 5 月期间插管的成年患者（≥18 岁）进行的回顾性图表审查，这些患者接受了推注血管加压素。主要结局是推注血管加压素给药的发生率和开始或增加持续血管加压素输注的频率。
在此期间，334 例插管患者中有 49 例（14.7%）在围插管期间接受了推注血管加压素。平均预插管休克指数为 1.1±0.5。接受推注血管加压素的患者中，34 例（69.4%）接受了多次推注；平均给药次数为 2.5±1.9。大多数患者存在持续或复发性低血压（n=39，79.6%）。15 例（30.6%）开始使用持续血管加压素输注，3 例（11.1%）在插管后增加了现有输注。
尽管在许多情况下推注血管加压素方便且合适，但它们不能充分解决基础休克的重症患者的低血压问题。需要进一步研究以更好地阐明围插管期推注和持续血管加压素在重症监护转运中的作用。
