The safety and efficacy of push dose vasopressors in critically ill adults

Am J Emerg Med. 2022 Nov:61:137-142. doi: 10.1016/j.ajem.2022.08.055. Epub 2022 Sep 5.

Abstract

Purpose: To evaluate practice patterns, efficacy, and safety of push dose pressors (PDP) in critically ill patients outside of the operating room (OR) at a large academic medical center.

Materials and methods: This was a single-center, retrospective cohort study (June 2018 to July 2020) conducted at a 1273-bed academic medical center. The primary outcome was efficacy, defined as a 25% increase in systolic blood pressure, and the cohort was analyzed according to PDP response (i.e. responders versus non-responders). A logistic regression model was used to assess predictors of response to PDPs. Safety outcomes included the incidence of hypertension, bradycardia, and tachycardia.

Results: 1727 patients were included in the final analysis. The median doses of phenylephrine and epinephrine administered were 400 μg (IQR 200-888 μg) and 50 μg (IQR 20-100 μg). The primary outcome was achieved in 102 (71.8%) patients in the epinephrine group and 1140 (55.9%) of patients in the phenylephrine group. Adverse effects after PDP receipt were minimal, with the most common being hypertension in 6.6% and 13.4% of the phenylephrine and epinephrine groups respectively.

Conclusions: This study demonstrates that PDP phenylephrine and epinephrine are safe and efficacious in treating the acute hypotensive period.

Keywords: Epinephrine; Hypotension; Phenylephrine; Push dose pressors; Vasopressors.

MeSH terms

  • Adult
  • Critical Illness*
  • Epinephrine / adverse effects
  • Humans
  • Hypertension* / chemically induced
  • Hypertension* / drug therapy
  • Phenylephrine / adverse effects
  • Retrospective Studies
  • Vasoconstrictor Agents / adverse effects

Substances

  • Vasoconstrictor Agents
  • Phenylephrine
  • Epinephrine