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Critical Care (London, England) Apr 2021It is unclear whether vasopressors can be safely administered through a peripheral intravenous (PIV). Systematic review and meta-analysis methodology was used to examine... (Meta-Analysis)
Meta-Analysis
BACKGROUND
It is unclear whether vasopressors can be safely administered through a peripheral intravenous (PIV). Systematic review and meta-analysis methodology was used to examine the incidence of local anatomic adverse events associated with PIV vasopressor administration in patients of any age cared for in any acute care environment.
METHODS
MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of controlled trials, and the Database of Abstracts of Reviews of Effects were searched without restriction from inception to October 2019. References of included studies and related reviews, as well as relevant conference proceedings were also searched. Studies were included if they were: (1) cohort, quasi-experimental, or randomized controlled trial study design; (2) conducted in humans of any age or clinical setting; and (3) reported on local anatomic adverse events associated with PIV vasopressor administration. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials or the Joanna Briggs Institute checklist for prevalence studies where appropriate. Incidence estimates were pooled using random effects meta-analysis. Subgroup analyses were used to explore sources of heterogeneity.
RESULTS
Twenty-three studies were included in the systematic review, of which 16 and 7 described adults and children, respectively. Meta-analysis from 11 adult studies including 16,055 patients demonstrated a pooled incidence proportion of adverse events associated with PIV vasopressor administration as 1.8% (95% CI 0.1-4.8%, I = 93.7%). In children, meta-analysis from four studies and 388 patients demonstrated a pooled incidence proportion of adverse events as 3.3% (95% CI 0.0-10.1%, I = 82.4%). Subgroup analyses did not detect any statistically significant effects associated with stratification based on differences in clinical location, risk of bias or design between studies, PIV location and size, or vasopressor type or duration. Most studies had high or some concern for risk of bias.
CONCLUSION
The incidence of adverse events associated with PIV vasopressor administration is low. Additional research is required to examine the effects of PIV location and size, vasopressor type and dose, and patient characteristics on the safety of PIV vasopressor administration.
Topics: Catheterization, Peripheral; Drug-Related Side Effects and Adverse Reactions; Humans; Vasoconstrictor Agents
PubMed: 33863361
DOI: 10.1186/s13054-021-03553-1 -
British Journal of Anaesthesia May 2022
Randomized Controlled Trial
Prophylactic norepinephrine or phenylephrine infusion for bradycardia and post-spinal anaesthesia hypotension in patients with preeclampsia during Caesarean delivery: a randomised controlled trial.
Topics: Anesthesia, Obstetrical; Anesthesia, Spinal; Bradycardia; Cesarean Section; Female; Humans; Hypotension; Norepinephrine; Phenylephrine; Pre-Eclampsia; Pregnancy; Vasoconstrictor Agents
PubMed: 35190176
DOI: 10.1016/j.bja.2022.01.027 -
The Journal of Dermatological Treatment Mar 2021Topical oxymetazoline and brimonidine are the only medications approved for treating persistent facial erythema of rosacea. This review aims to investigate the efficacy,... (Review)
Review
OBJECTIVE
Topical oxymetazoline and brimonidine are the only medications approved for treating persistent facial erythema of rosacea. This review aims to investigate the efficacy, safety, pharmacodynamics, and pharmacokinetic properties of oxymetazoline and brimonidine.
METHODS AND MATERIALS
Phase II and phase III clinical studies evaluating oxymetazoline and brimonidine were assessed to compare their efficacy and safety.
RESULTS
In their respective phase III trials, both oxymetazoline and brimonidine met the primary efficacy outcome of having at least a 2-grade decrease from baseline on both the Clinician Erythema Assessment (CEA) and the Subject Self-Assessment (SSA) Scales compared to the vehicle control. Treatment related adverse events of oxymetazoline and brimonidine are most often mild and localized.
CONCLUSIONS
Topical oxymetazoline and brimonidine are effective for the management of persistent facial erythema associated with rosacea with a few mild and localized adverse effects. Further long-term research is imperative to further understand their long-term effects.
Topics: Administration, Topical; Brimonidine Tartrate; Clinical Trials as Topic; Dermatitis; Erythema; Humans; Oxymetazoline; Rosacea; Treatment Outcome; Vasoconstrictor Agents
PubMed: 31294643
DOI: 10.1080/09546634.2019.1639606 -
BMC Infectious Diseases Apr 2023vasopressin is commonly used as a second-line vasopressor for patients with septic shock, but the optimal timing of initiation is uncertain. This study was designed to... (Observational Study)
Observational Study
BACKGROUND
vasopressin is commonly used as a second-line vasopressor for patients with septic shock, but the optimal timing of initiation is uncertain. This study was designed to investigate when vasopressin initiation may be beneficial for 28-day mortality in septic shock patients.
METHODS
This was a retrospective observational cohort study from the MIMIC-III v1.4 and MIMIC-IV v2.0 databases. All adults diagnosed with septic shock according to Sepsis-3 criteria were included. Patients were stratified into two groups based on norepinephrine (NE) dose at the time of vasopressin initiation, defined as the low doses of NE group (NE<0.25 µg/kg/min) and the high doses of NE group (NE ≥ 0.25 µg/kg/min). The primary end-point was 28-day mortality after diagnosis of septic shock. The analysis involved propensity score matching (PSM), multivariable logistic regression, doubly robust estimation, the gradient boosted model, and an inverse probability-weighting model.
RESULTS
A total of 1817 eligible patients were included in our original cohort (613 in the low doses of NE group and 1204 in the high doses of NE group). After 1:1 PSM, 535 patients from each group with no difference in disease severity were included in the analysis. The results showed that vasopressin initiation at low doses of NE was associated with reduced 28-day mortality (odds ratio [OR] 0.660, 95% confidence interval [CI] 0.518-0.840, p < 0.001). Compared with patients in the high doses of NE group, patients in the low doses of NE group received significantly shorter duration of NE, with less intravenous fluid volume on the first day after initiation of vasopressin, more urine on the second day, and longer mechanical ventilation-free days and CRRT-free days. Nevertheless, there were no significant differences in hemodynamic response to vasopressin, duration of vasopressin, and ICU or hospital length of stay.
CONCLUSIONS
Among adults with septic shock, vasopressin initiation when low-dose NE was used was associated with an improvement in 28-day mortality.
Topics: Adult; Humans; Shock, Septic; Cohort Studies; Vasoconstrictor Agents; Vasopressins; Norepinephrine; Retrospective Studies
PubMed: 37013474
DOI: 10.1186/s12879-023-08147-6 -
Emergency Medicine Journal : EMJ Nov 2020Refractory hypotension is one of the most common and difficult clinical problems faced by acute care clinicians, and it poses a particularly large problem to the... (Review)
Review
Refractory hypotension is one of the most common and difficult clinical problems faced by acute care clinicians, and it poses a particularly large problem to the emergency physician when a patient in undifferentiated shock arrives in the department. Angiotensin II (Ang-2) has been previously used as a vasopressor to combat shock; the feasibility of its clinical use has been reinvigorated after approval of a human synthetic formulation of the medication by the US Food and Drug Administration in 2017 and the European Medicines Agency in 2019. A thorough literature search was completed, and in this review, we discuss the discovery and development of Ang-2, its complex mechanisms of vasoconstriction, its potential adverse effects and its potential role in clinical practice for emergency physicians.
Topics: Angiotensin II; Critical Care; Emergency Service, Hospital; Humans; Hypotension; Shock; Vasoconstrictor Agents
PubMed: 32075849
DOI: 10.1136/emermed-2019-209062 -
Journal of Special Operations Medicine... May 2022Shock is a life-threatening condition carrying a high mortality rate when untreated. The consequences of shock are cellular and metabolic derangements, which are...
Shock is a life-threatening condition carrying a high mortality rate when untreated. The consequences of shock are cellular and metabolic derangements, which are initially reversible. The authors present the case of a Servicemember who sustained mortar shrapnel wounds that resulted in shock.
Topics: Humans; Shock; Vasoconstrictor Agents
PubMed: 35639896
DOI: 10.55460/24JR-XNAS -
Current Opinion in Critical Care Aug 2020Data and interventional trials on vasopressor use during cardiogenic shock are scarce. Their use is limited by their side-effects and the lack of solid evidence... (Review)
Review
PURPOSE OF REVIEW
Data and interventional trials on vasopressor use during cardiogenic shock are scarce. Their use is limited by their side-effects and the lack of solid evidence regarding their effectiveness in improving outcomes. In the present article, we review the current use of vasopressor therapy during cardiogenic shock.
RECENT FINDINGS
Two recent Cochrane analyses concluded that there was insufficient evidence to prove that any one vasopressor was superior to others in terms of mortality. A recent RCT and a meta-analysis on individual data suggested that norepinephrine may be preferred over epinephrine in patients with cardiogenic shock, in particular, after myocardial infarction. In patients with right ventricular failure and pulmonary hypertension, the use of vasopressin may be advocated under advanced monitoring.
SUMMARY
When blood pressure needs to be restored, norepinephrine is a reasonable first-line agent. Information regarding comparative effective outcomes is sparse and their use should be limited to a temporary measure as a bridge to recovery, mechanical circulatory support or heart transplantation.
Topics: Epinephrine; Heart Failure; Humans; Norepinephrine; Shock, Cardiogenic; Vasoconstrictor Agents
PubMed: 32487842
DOI: 10.1097/MCC.0000000000000743 -
Chest Feb 2020
Topics: Humans; Shock, Cardiogenic; Vasoconstrictor Agents
PubMed: 32033651
DOI: 10.1016/j.chest.2019.10.018 -
Current Opinion in Gastroenterology May 2024The definition and diagnostic criteria of hepatorenal syndrome-acute kidney injury (HRS-AKI) has undergone recent changes. A major vasoconstrictor, terlipressin, has... (Review)
Review
PURPOSE OF REVIEW
The definition and diagnostic criteria of hepatorenal syndrome-acute kidney injury (HRS-AKI) has undergone recent changes. A major vasoconstrictor, terlipressin, has recently been approved as pharmacotherapy for HRS-AKI in the United States. The purpose of this review is to familiarize the readers with these new diagnostic criteria of HRS-AKI, and how best to use terlipressin.
RECENT FINDINGS
Terlipressin is effective either as bolus dosing or continuous infusion and can achieve reversal of HRS-AKI in approximately 40% of patients. Continuous infusion allows lower daily dose with equal efficacy and less side effects but not an approved mode of administration in the United States. Response to terlipressin in the randomized controlled trials was defined as repeat reduction of serum creatinine to less than 1.5 mg/dl. Newer studies will likely require response to treatment to be defined as a repeat serum creatinine to be less than 0.3 mg/dl from baseline. Terlipressin use is associated with ischemic side effects and potential for respiratory failure development.
SUMMARY
Careful patient selection and close monitoring are necessary for its use. Response to terlipressin with HRS-AKI reversal is associated with improved outcomes with better survival and less requirement for renal replacement therapy.
Topics: Humans; Terlipressin; Lypressin; Hepatorenal Syndrome; Creatinine; Treatment Outcome; Vasoconstrictor Agents; Acute Kidney Injury
PubMed: 38353275
DOI: 10.1097/MOG.0000000000001016 -
Critical Care Nursing QuarterlyCardiogenic shock (CS) is a complex and dreadful condition for which effective treatments remain unclear. The concerningly high mortality rate of CS emphasizes a need... (Review)
Review
Cardiogenic shock (CS) is a complex and dreadful condition for which effective treatments remain unclear. The concerningly high mortality rate of CS emphasizes a need for developing effective therapies to reduce its mortality and reverse its detrimental course. This article aims to provide an updated and evidence-based review of the pathophysiology of CS and the related pharmacotherapeutics with a special focus on vasoactive and inotropic agents.
Topics: Humans; Shock, Cardiogenic; Cardiotonic Agents; Vasoconstrictor Agents
PubMed: 38860953
DOI: 10.1097/CNQ.0000000000000513