Comparison of push-dose phenylephrine and epinephrine in the emergency department
There is limited evidence to support the efficacy and safety of push-dose vasopressor (PDP) use outside of the operating room (OR). Specifically, there are few head-to-head comparisons of different PDP in these settings. The purpose of this study was to compare the efficacy and safety of push-dose p...
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| Veröffentlicht in: | The American journal of emergency medicine 2022-02, Vol.52, p.43-49 |
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| creator | Nam, Elizabeth Fitter, Scott Moussavi, Kayvan |
| description | There is limited evidence to support the efficacy and safety of push-dose vasopressor (PDP) use outside of the operating room (OR). Specifically, there are few head-to-head comparisons of different PDP in these settings. The purpose of this study was to compare the efficacy and safety of push-dose phenylephrine (PDP-PE) and epinephrine (PDP-E) in the Emergency Department (ED).
This retrospective, single-center study evaluated adults given PDP-PE or PDP-E in the ED from May 2017 to November 2020. The primary outcome was a change in heart rate (HR). Secondary outcomes included changes in blood pressure, adverse effects, dosing errors, fluid and vasopressor requirements, ICU and hospital lengths of stay (LOS), and in-hospital mortality.
Ninety-six patients were included in the PDP-PE group and 39 patients in the PDP-E group. Median changes in HR were 0 [−7, 6] and − 2 [−15, 5] beats per minute (BPM) for PDP-PE and PDP-E, respectively (p = 0.138). PDP-E patients had a greater median increase in systolic blood pressure (SBP) (33 [24, 53] vs. 26 [8, 51] mmHg; p = 0.049). Dosing errors occurred more frequently in patients that received PDP-E (5/39 [12.8%] vs. 2/96 [2.1%]; p = 0.021). PDP-E patients more frequently received continuous epinephrine infusions before and after receiving PDP-E. There were no differences in adverse effects, fluid requirements, LOS, or mortality.
PDP-E provided a greater increase in SBP compared to PDP-PE. However, dosing errors occurred more frequently in those receiving PDP-E. Larger head-to-head studies are necessary to further evaluate the efficacy and safety of PDP-E and PDP-PE. |
| doi_str_mv | 10.1016/j.ajem.2021.11.033 |
| format | Article |
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This retrospective, single-center study evaluated adults given PDP-PE or PDP-E in the ED from May 2017 to November 2020. The primary outcome was a change in heart rate (HR). Secondary outcomes included changes in blood pressure, adverse effects, dosing errors, fluid and vasopressor requirements, ICU and hospital lengths of stay (LOS), and in-hospital mortality.
Ninety-six patients were included in the PDP-PE group and 39 patients in the PDP-E group. Median changes in HR were 0 [−7, 6] and − 2 [−15, 5] beats per minute (BPM) for PDP-PE and PDP-E, respectively (p = 0.138). PDP-E patients had a greater median increase in systolic blood pressure (SBP) (33 [24, 53] vs. 26 [8, 51] mmHg; p = 0.049). Dosing errors occurred more frequently in patients that received PDP-E (5/39 [12.8%] vs. 2/96 [2.1%]; p = 0.021). PDP-E patients more frequently received continuous epinephrine infusions before and after receiving PDP-E. There were no differences in adverse effects, fluid requirements, LOS, or mortality.
PDP-E provided a greater increase in SBP compared to PDP-PE. However, dosing errors occurred more frequently in those receiving PDP-E. Larger head-to-head studies are necessary to further evaluate the efficacy and safety of PDP-E and PDP-PE.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2021.11.033</identifier><identifier>PMID: 34864289</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adrenergic receptors ; Aged ; Beta blockers ; Blood pressure ; Blood Pressure - drug effects ; Cardiac arrhythmia ; Dosage ; Drug dosages ; Emergency medical care ; Emergency Service, Hospital - organization & administration ; Emergency Service, Hospital - statistics & numerical data ; Epinephrine ; Epinephrine - administration & dosage ; Epinephrine - adverse effects ; Female ; Heart rate ; Heart Rate - drug effects ; Human error ; Humans ; Hypotension ; Male ; Middle Aged ; Mortality ; Patients ; Pharmacology ; Phenylephrine ; Phenylephrine - administration & dosage ; Phenylephrine - adverse effects ; Retrospective Studies ; Safety ; Shock ; Side effects ; Statistical analysis ; Vasoconstrictor Agents - administration & dosage ; Vasoconstrictor Agents - adverse effects ; Vasopressor ; Vital signs</subject><ispartof>The American journal of emergency medicine, 2022-02, Vol.52, p.43-49</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><rights>2021. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-861ff982db845e149c683b6c4d859ac5b6c8ccd983cbbd7a55f99b6916b8357c3</citedby><cites>FETCH-LOGICAL-c384t-861ff982db845e149c683b6c4d859ac5b6c8ccd983cbbd7a55f99b6916b8357c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2619204876?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974,64362,64364,64366,72216</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34864289$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nam, Elizabeth</creatorcontrib><creatorcontrib>Fitter, Scott</creatorcontrib><creatorcontrib>Moussavi, Kayvan</creatorcontrib><title>Comparison of push-dose phenylephrine and epinephrine in the emergency department</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>There is limited evidence to support the efficacy and safety of push-dose vasopressor (PDP) use outside of the operating room (OR). Specifically, there are few head-to-head comparisons of different PDP in these settings. The purpose of this study was to compare the efficacy and safety of push-dose phenylephrine (PDP-PE) and epinephrine (PDP-E) in the Emergency Department (ED).
This retrospective, single-center study evaluated adults given PDP-PE or PDP-E in the ED from May 2017 to November 2020. The primary outcome was a change in heart rate (HR). Secondary outcomes included changes in blood pressure, adverse effects, dosing errors, fluid and vasopressor requirements, ICU and hospital lengths of stay (LOS), and in-hospital mortality.
Ninety-six patients were included in the PDP-PE group and 39 patients in the PDP-E group. Median changes in HR were 0 [−7, 6] and − 2 [−15, 5] beats per minute (BPM) for PDP-PE and PDP-E, respectively (p = 0.138). PDP-E patients had a greater median increase in systolic blood pressure (SBP) (33 [24, 53] vs. 26 [8, 51] mmHg; p = 0.049). Dosing errors occurred more frequently in patients that received PDP-E (5/39 [12.8%] vs. 2/96 [2.1%]; p = 0.021). PDP-E patients more frequently received continuous epinephrine infusions before and after receiving PDP-E. There were no differences in adverse effects, fluid requirements, LOS, or mortality.
PDP-E provided a greater increase in SBP compared to PDP-PE. However, dosing errors occurred more frequently in those receiving PDP-E. Larger head-to-head studies are necessary to further evaluate the efficacy and safety of PDP-E and PDP-PE.</description><subject>Adrenergic receptors</subject><subject>Aged</subject><subject>Beta blockers</subject><subject>Blood pressure</subject><subject>Blood Pressure - drug effects</subject><subject>Cardiac arrhythmia</subject><subject>Dosage</subject><subject>Drug dosages</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital - organization & administration</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Epinephrine</subject><subject>Epinephrine - administration & dosage</subject><subject>Epinephrine - adverse effects</subject><subject>Female</subject><subject>Heart rate</subject><subject>Heart Rate - drug effects</subject><subject>Human error</subject><subject>Humans</subject><subject>Hypotension</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Patients</subject><subject>Pharmacology</subject><subject>Phenylephrine</subject><subject>Phenylephrine - administration & dosage</subject><subject>Phenylephrine - adverse effects</subject><subject>Retrospective Studies</subject><subject>Safety</subject><subject>Shock</subject><subject>Side effects</subject><subject>Statistical analysis</subject><subject>Vasoconstrictor Agents - administration & dosage</subject><subject>Vasoconstrictor Agents - adverse effects</subject><subject>Vasopressor</subject><subject>Vital signs</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kM-r1DAQx4Movn1P_wEPUvDipTXT_GgCXmTRp_BABD2HNpm6KdukJu2D_e_NsqsHD55mBj7zZeZDyCugDVCQ76amn3BuWtpCA9BQxp6QHQjW1go6eEp2tGOilp3obshtzhOlAFzw5-SGcSV5q_SOfNvHeemTzzFUcayWLR9qFzNWywHD6YjLIfmAVR9chUvprrMP1XrACmdMPzHYU-WwpKwzhvUFeTb2x4wvr_WO_Pj08fv-c_3w9f7L_sNDbZnia60kjKNWrRsUFwhcW6nYIC13SujeitIqa51WzA6D63ohRq0HqUEOionOsjvy9pK7pPhrw7ya2WeLx2MfMG7ZtLK8TzWlsqBv_kGnuKVQrisU6JZy1Z2p9kLZFHNOOJol-blPJwPUnIWbyZyFm7NwA2CK8LL0-hq9DTO6vyt_DBfg_QXA4uLRYzLZ-qIMnU9oV-Oi_1_-b9q6kZg</recordid><startdate>202202</startdate><enddate>202202</enddate><creator>Nam, Elizabeth</creator><creator>Fitter, Scott</creator><creator>Moussavi, Kayvan</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202202</creationdate><title>Comparison of push-dose phenylephrine and epinephrine in the emergency department</title><author>Nam, Elizabeth ; 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Specifically, there are few head-to-head comparisons of different PDP in these settings. The purpose of this study was to compare the efficacy and safety of push-dose phenylephrine (PDP-PE) and epinephrine (PDP-E) in the Emergency Department (ED).
This retrospective, single-center study evaluated adults given PDP-PE or PDP-E in the ED from May 2017 to November 2020. The primary outcome was a change in heart rate (HR). Secondary outcomes included changes in blood pressure, adverse effects, dosing errors, fluid and vasopressor requirements, ICU and hospital lengths of stay (LOS), and in-hospital mortality.
Ninety-six patients were included in the PDP-PE group and 39 patients in the PDP-E group. Median changes in HR were 0 [−7, 6] and − 2 [−15, 5] beats per minute (BPM) for PDP-PE and PDP-E, respectively (p = 0.138). PDP-E patients had a greater median increase in systolic blood pressure (SBP) (33 [24, 53] vs. 26 [8, 51] mmHg; p = 0.049). Dosing errors occurred more frequently in patients that received PDP-E (5/39 [12.8%] vs. 2/96 [2.1%]; p = 0.021). PDP-E patients more frequently received continuous epinephrine infusions before and after receiving PDP-E. There were no differences in adverse effects, fluid requirements, LOS, or mortality.
PDP-E provided a greater increase in SBP compared to PDP-PE. However, dosing errors occurred more frequently in those receiving PDP-E. Larger head-to-head studies are necessary to further evaluate the efficacy and safety of PDP-E and PDP-PE.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34864289</pmid><doi>10.1016/j.ajem.2021.11.033</doi><tpages>7</tpages></addata></record> |
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| subjects | Adrenergic receptors Aged Beta blockers Blood pressure Blood Pressure - drug effects Cardiac arrhythmia Dosage Drug dosages Emergency medical care Emergency Service, Hospital - organization & administration Emergency Service, Hospital - statistics & numerical data Epinephrine Epinephrine - administration & dosage Epinephrine - adverse effects Female Heart rate Heart Rate - drug effects Human error Humans Hypotension Male Middle Aged Mortality Patients Pharmacology Phenylephrine Phenylephrine - administration & dosage Phenylephrine - adverse effects Retrospective Studies Safety Shock Side effects Statistical analysis Vasoconstrictor Agents - administration & dosage Vasoconstrictor Agents - adverse effects Vasopressor Vital signs |
| title | Comparison of push-dose phenylephrine and epinephrine in the emergency department |
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