Munroe Elizabeth S, Co Ivan N, Douglas Ivor, Hyzy Robert, Khan Akram, Nelson Kristine, Park Pauline K, Peltan Ithan D, Rice Todd W, Seelye Sarah, Self Wesley H, Shapiro Nathan I, Prescott Hallie C
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor.
Department of Emergency Medicine, University of Michigan, Ann Arbor.
JAMA Netw Open. 2025 Aug 1;8(8):e2529148. doi: 10.1001/jamanetworkopen.2025.29148.
Evidence supporting the safety of infusing vasopressors through peripheral intravenous catheters (peripheral vasopressors) is largely derived from single-center studies, limiting generalizability.
To evaluate factors associated with vasopressor route selection and assess safety and clinical outcomes of peripheral vasopressor administration in early sepsis resuscitation.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study is a secondary analysis of the Crystalloid Liberal vs Early Vasopressors in Sepsis (CLOVERS) trial conducted in 60 US hospitals from March 2018 to February 2022. Patients in CLOVERS who received vasopressors within 24 hours of enrollment and did not have central venous access at enrollment were included. Data were analyzed from January 2023 to June 2025.
Route of vasopressor initiation (central or peripheral).
The primary analysis evaluated the route of vasopressor initiation, while the secondary analysis assessed continuation of peripheral vasopressors beyond 6 hours. Univariable and multivariable analyses of factors associated with vasopressor route were conducted, as was a multivariable analysis to evaluate the association of route with outcomes, including 90-day mortality. Descriptive statistics were used to summarize 28-day peripheral vasopressor and central venous catheter (CVC) complications.
Of 1563 patients in CLOVERS, 582 (37.2%) received vasopressors and met study inclusion criteria. Included patients had a median (IQR) age of 63 (52-72) years, and 267 (45.9%) were female, 96 (16.5%) were African American, 416 (71.5%) were White, and 70 (12.0%) were another race or had unreported race. Vasopressors were initiated via peripheral catheter in 490 patients (84.2%) and via central venous access in 92 patients (15.8%). Study site was the only factor independently associated with route of initiation (median odds ratio, 3.48; 95% CI, 1.57-5.38). In adjusted analyses, peripheral vs central initiation was associated with statistically comparable 90-day mortality (128 participants [26.1%] vs 34 participants [37.0%]; adjusted odds ratio, 0.67; 95% CI, 0.39-1.16). Peripheral vasopressors were continued beyond 6 hours in 333 of 490 patients (68.0%). Peripheral vasopressor complications were rare and low-grade (3 of 490 patients [0.6%]), with no cases of ulceration or tissue injury. In contrast, there were 14 complications from CVC placement occurring in 12 of 322 patients (3.7%) who had CVCs placed in the first 72 hours.
In this prospective cohort study of the CLOVERS trial, peripheral administration of vasopressors was common and was associated with low complication rates. These findings support the safety and feasibility of short-term peripheral vasopressor use in early sepsis resuscitation.
支持通过外周静脉导管输注血管升压药（外周血管升压药）安全性的证据主要来自单中心研究，限制了其普遍性。
评估与血管升压药给药途径选择相关的因素，并评估外周血管升压药在早期脓毒症复苏中的安全性和临床结局。
设计、地点和参与者：这项前瞻性队列研究是对2018年3月至2022年2月在美国60家医院进行的脓毒症晶体液大量输注与早期血管升压药（CLOVERS）试验的二次分析。纳入CLOVERS中在入组后24小时内接受血管升压药且入组时没有中心静脉通路的患者。数据于2023年1月至2025年6月进行分析。
血管升压药起始给药途径（中心或外周）。
主要分析评估血管升压药起始给药途径，次要分析评估外周血管升压药使用超过6小时的情况。对与血管升压药给药途径相关的因素进行单变量和多变量分析，并进行多变量分析以评估给药途径与结局（包括90天死亡率）之间的关联。使用描述性统计总结28天外周血管升压药和中心静脉导管（CVC）并发症。
在CLOVERS的1563例患者中，582例（37.2%）接受了血管升压药并符合研究纳入标准。纳入患者的年龄中位数（四分位间距）为63（52 - 72）岁，267例（45.9%）为女性，96例（16.5%）为非裔美国人，416例（71.5%）为白人，70例（12.0%）为其他种族或种族未报告。490例患者（84.2%）通过外周导管起始使用血管升压药，92例患者（15.8%）通过中心静脉通路起始使用。研究地点是唯一与起始给药途径独立相关的因素（中位数比值比，3.48；95%置信区间，1.57 - 5.38）。在调整分析中，外周起始与中心起始相比，90天死亡率在统计学上相当（128例参与者[26.1%] vs 34例参与者[37.0%]；调整后比值比，0.67；95%置信区间，0.39 - 1.16）。490例患者中有333例（68.0%）外周血管升压药使用超过6小时。外周血管升压药并发症罕见且程度较轻（490例患者中有3例[0.6%]），无溃疡或组织损伤病例。相比之下，在最初72小时内放置CVC的322例患者中有12例（3.7%）发生了14例CVC放置相关并发症。
在这项关于CLOVERS试验的前瞻性队列研究中，外周给予血管升压药很常见且并发症发生率低。这些发现支持了在早期脓毒症复苏中短期外周使用血管升压药安全可行。
