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首页> 外文期刊>The Canadian journal of hospital pharmacy. >Va so press in for Septic Shock in a Medical-Surgical Intensive Care Unit
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Va so press in for Septic Shock in a Medical-Surgical Intensive Care Unit

机译：VA在医疗外科重症监护病房中为脓毒休克进行碎片

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Background: Critically ill patients often need vasopressors to treat hypotension related to septic shock and to maintain adequate systemic perfusion. Although the 2017 guidelines of the Surviving Sepsis Campaign recommend norepinephrine as first-line therapy, they also state that vasopressin may be considered as an adjunctive agent for patients with refractory shock. Limited evidence is available for directing optimal administration of vasopressin. As such, prescribing practices are not standardized and may vary according to the particular clinician, the clinical scenario, and various patient-specific factors. Objectives: To review the current practice of administering concomitant norepinephrine and vasopressin therapy to patients with septic shock, to describe variability in vasopressin administration, and to evaluate effects on patient safety in a medical-surgical intensive care unit (ICU). Methods: This single-centre retrospective chart review involved 100 adult patients admitted to the ICU who received vasopressin and norepinephrine for septic shock between April and December 2017. The data were analyzed with descriptive statistics. Results: The mean time to initiation of vasopressin was 12.0 (standard deviation [SD] 21.6) h after initiation of norepinephrine. The mean dose of norepinephrine at the time of vasopressin initiation was 29.5 (SD 19.7) ug/min. The mean vasopressin dose prescribed was 0.04 (SD 0.03) units/min, with a range of tapering and discontinuation regimens. The mean duration of vasopressin therapy was 49.1 (SD 65.2) h, and vasopressin was discontinued before norepinephrine in 49 of the patients. A total of 60 hypotensive events occurred after vasopressor discontinuation and were more common when vasopressin was discontinued before norepinephrine. Conclusions: Vasopressin dosing was comparable to that reported elsewhere; however, discontinuation practices were inconsistent. These results show that variability in the literature supporting vasopressin use has led to variability in vasopressin administration and discontinuation practices; however, correlation with improvement in clinical outcomes, such as mortality or ICU length of stay, is unclear, and further research is required to determine the ideal approach to vasopressin use.
机译：背景：危重病人通常需要血管升压药来治疗与感染性休克相关的低血压，并维持充分的全身灌注。尽管2017年存活败血症运动指南建议将去甲肾上腺素作为一线治疗，但它们也指出，血管加压素可被视为难治性休克患者的辅助药物。可用于指导血管加压素最佳给药的证据有限。因此，开处方的做法没有标准化，可能会根据特定的临床医生、临床场景和各种患者特定的因素而有所不同。目的：回顾感染性休克患者同时服用去甲肾上腺素和血管加压素治疗的当前实践，描述血管加压素服用的变异性，并评估在内科外科重症监护病房（ICU）中对患者安全的影响。方法：这项单中心回顾性图表回顾涉及100名在2017年4月至12月期间因感染性休克接受加压素和去甲肾上腺素治疗的ICU成年患者。数据采用描述性统计分析。结果：去甲肾上腺素开始使用后，血管加压素开始使用的平均时间为12.0（标准差[SD]21.6）h。血管加压素开始使用时，去甲肾上腺素的平均剂量为29.5（SD 19.7）ug/min。处方的血管加压素平均剂量为0.04（SD 0.03）单位/min，包括一系列逐渐减少和停药方案。加压素治疗的平均持续时间为49.1（SD 65.2）h，其中49名患者在使用去甲肾上腺素之前停用加压素。共有60例低血压事件发生在血管加压素停用后，在去甲肾上腺素之前停用血管加压素时更常见。结论：加压素的剂量与其他地方报道的相当；然而，中止的做法并不一致。这些结果表明，支持血管加压素使用的文献中的变异性导致了血管加压素给药和停药实践的变异性；然而，与临床结果改善（如死亡率或ICU住院时间）的相关性尚不清楚，需要进一步研究以确定使用血管加压素的理想方法。

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