Vasopressor Administration via Peripheral Intravenous Access for Emergency Department Stabilization in Septic Shock Patients.

Autor: Kilian S; Department of Emergency Medicine, Washington University in St Louis, School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, United States of America., Surrey A; Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St Louis, School of Medicine, St Louis, Missouri, United States of America., McCarron W; Department of Emergency Medicine, Washington University in St Louis, School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, United States of America., Mueller K; Department of Emergency Medicine, Washington University in St Louis, School of Medicine, St Louis, Missouri, United States of America., Wessman BT; Department of Anesthesiology and Emergency Medicine, Washington University in St Louis, School of Medicine, St Louis, Missouri, United States of America.
Jazyk: angličtina
Zdroj: Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine [Indian J Crit Care Med] 2022 Jul; Vol. 26 (7), pp. 811-815.
DOI: 10.5005/jp-journals-10071-24243
Abstrakt: Background: Septic shock is commonly treated in the emergency department (ED) with vasopressors. Prior data have shown that vasopressor administration through a peripheral intravenous line (PIV) is feasible.
Objectives: To characterize vasopressor administration for patients presenting to an academic ED in septic shock.
Materials and Methods: Retrospective observational cohort study evaluating initial vasopressor administration for septic shock. ED patients from June 2018 to May 2019 were screened. Exclusion criteria included other shock states, hospital transfers, or heart failure history. Patient demographics, vasopressor data, and length of stay (LOS) were collected. Cases were grouped by initiation site: PIV, ED placed central line (ED-CVL), or tunneled port/indwelling central line (Prior-CVL).
Results: Of the 136 patients identified, 69 were included. Vasopressors were initiated via PIV in 49%, ED-CVL in 25%, and prior-CVL in 26%. The time to initiation was 214.8 minutes in PIV and 294.7 minutes in ED-CVL ( p = 0.240). Norepinephrine predominated all groups. No extravasation or ischemic complications were identified with PIV vasopressor administration. Twenty-eight-day mortality was 20.6% for PIV, 17.6% for ED-CVL, and 61.1% for prior-CVL. Of 28-day survivors, ICU LOS was 4.44 for PIV and 4.86 for ED-CVL ( p = 0.687), while vasopressor days were 2.26 for PIV and 3.14 for ED-CVL ( p = 0.050).
Conclusion: Vasopressors are being administered via PIVs for ED septic shock patients. Norepinephrine comprised the majority of initial PIV vasopressor administration. There were no documented episodes of extravasation or ischemia. Further studies should look at the duration of PIV administration with potential avoidance of central venous cannulation altogether in appropriate patients.
How to Cite This Article: Kilian S, Surrey A, McCarron W, Mueller K, Wessman BT. Vasopressor Administration via Peripheral Intravenous Access for Emergency Department Stabilization in Septic Shock Patients. Indian J Crit Care Med 2022;26(7):811-815.
Competing Interests: Source of support: Nil Conflict of interest: None
(Copyright © 2022; Jaypee Brothers Medical Publishers (P) Ltd.)
Databáze: MEDLINE
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