医学
四分位间距
回顾性队列研究
导管
中心静脉导管
麻醉
感染性休克
输液疗法
血管活性
休克(循环)
队列
外科
败血症
内科学
作者
Robert J. Levy,Pamela D. Reiter,Matthew A. Spear,Alison Santana,Lori J. Silveira,Shaina Cox,Peter M. Mourani,Aline B Maddux
出处
期刊:Pediatric Critical Care Medicine
[Ovid Technologies (Wolters Kluwer)]
日期:2022-04-21
卷期号:23 (8): 618-625
被引量:3
标识
DOI:10.1097/pcc.0000000000002970
摘要
OBJECTIVES: Management of fluid refractory pediatric shock requires prompt administration of vasoactive agents. Although delivery of vasoactive therapy is generally provided via a central venous catheter, their placement can delay drug administration and is associated with complications. We characterize peripheral vasoactive administration in a cohort of critically ill children with shock, evaluate progression to central venous catheter placement, and describe complications associated with extravasation. DESIGN: Retrospective cohort study. SETTING: Single-center, quaternary PICU (January 2010 to December 2015). PATIENTS: Children (31 d to 18 yr) who received epinephrine, norepinephrine, or dopamine. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We compared patients based on the initial site of vasoactive infusion: peripheral venous access (PVA) or central venous access (CVA) and, within the PVA group, compared patients based on subsequent placement of a central catheter for vasoactive infusion. We also characterized peripheral extravasations. We evaluated 756 patients: 231 (30.6%) PVA and 525 (69.4%) CVA patients. PVA patients were older, had lower illness severity, and more frequently had vasoactive therapy initiated at night compared with CVA patients. In PVA patients, 124 (53.7%) had a central catheter placed after a median of 140 minutes (interquartile range, 65–247 min) of peripheral treatment. Patients who avoided central catheter placement had lower illness severity. Of the 93 patients with septic shock, 44 (47.3%) did not have a central catheter placed. Extravasations occurred in four of 231 (1.7% [95% CI, 0.03–3.4]) PVA patients, exclusively in the hand. Three patients received pharmacologic intervention, and none had long-term disabilities. CONCLUSIONS: In our experience, peripheral venous catheters can be used for vasoactive administration. In our series, the upper limit of the 95% CI for extravasation is approximately 1-in-30, meaning that this route may be an appropriate option while evaluating the need for central access, particularly in patients with low illness severity.
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