| Autor: | Jonathan H. Sin, Mia Choi, Kelly Newman, Megan E Barra |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Critical Care Chlorpromazine Critical Illness Blood Pressure Critical Care and Intensive Care Medicine law.invention Tertiary Care Centers 03 medical and health sciences 0302 clinical medicine law Heart Rate medicine Humans Hypnotics and Sedatives Vasoconstrictor Agents Intensive care medicine Critical Care Outcomes Psychomotor Agitation Aged Retrospective Studies Critically ill business.industry Incidence 030208 emergency & critical care medicine Arrhythmias Cardiac Middle Aged Intensive care unit Intensive Care Units Treatment Outcome 030228 respiratory system Administration Intravenous Female business Antipsychotic Agents medicine.drug |
| Zdroj: | Critical Care Medicine. 47:61 |
| ISSN: | 0090-3493 |
| DOI: | 10.1097/01.ccm.0000550913.71396.f6 |
| Popis: | Background: Agitation is common in the intensive care unit (ICU). Although antipsychotics are frequently used as first-line therapy, chlorpromazine has fallen out of favor due to risk of cardiovascular complications and severe hypotension. Although chlorpromazine is used anecdotally, there is a lack of data regarding its safety and effectiveness. The objective of this study was to investigate the use of intravenous (IV) chlorpromazine for agitation in the ICU setting. Methods: A retrospective review was performed at a tertiary care academic medical center. Patients were included if they received IV chlorpromazine in the ICU for agitation, infused at a rate of 1 mg/min. Primary end points were change in systolic blood pressure (SBP), heart rate (HR), and mean arterial pressure (MAP) within 4 hours of administration. Secondary end points included change in vasopressor and adjunct sedative medication requirements, achievement of Richmond-Agitation Sedation Scale (RASS) 0 to −1, and incidence of cardiac arrhythmias. Results: A total of 39 patients encompassing 107 IV chlorpromazine administrations were included. The median dose was 25 mg. Median vital signs prior to infusion were SBP 129 mm Hg, HR 90 beats/minute, and MAP 88 mm Hg. Over the subsequent 4 hours, SBP and HR did not change significantly ( P = .83 and P = .10, respectively). Mean arterial pressure decreased from a median of 88 to 83 mm Hg ( P = .04). There were no significant changes in vasopressor requirements, adjunct sedative medication requirements, or achievement of RASS goal. No patients developed symptomatic cardiac arrhythmias. Conclusion: In our small retrospective study, the use of IV chlorpromazine at routine doses did not result in clinically significant hemodynamic changes when infused at a rate of 1 mg/min. Intravenous chlorpromazine may be considered as a potential treatment option for agitation in ICU patients with appropriate monitoring. |
| Databáze: | OpenAIRE |
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