Early Vasopressor Utilization in Critically Ill Patients With Acute Traumatic Spinal Cord Injury: A Retrospective Cohort Study.

IF 7.7 1区 医学 Q1 CRITICAL CARE MEDICINE
Mona Hashemaghaie, Tetsu Ohnuma, Ruba Sajdeya, Shreya Khandelwal, N David Yanez, Vijay Krishnamoorthy, Karthik Raghunathan, Michael J Devinney, Aparna Depuru, Miriam M Treggiari
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引用次数: 0

Abstract

Objectives: Evidence regarding vasopressor support for acute spinal cord injury (SCI) is lacking. We report early vasopressor use and hospital outcomes in patients with SCI.

Design: Propensity-score standardized mortality ratio-weighted retrospective cohort study.

Setting: U.S. hospitals participating in the Premier Healthcare Database, 2016-2020.

Patients: Adults 18 years old or older with acute traumatic SCI at T8 level or above who received vasopressors within 48 hours of hospitalization.

Interventions: None.

Measurements and main results: Of 3636 patients included (mean [sd] age, 56 [19]; 2757 [75%] males), 2055 (57%) received phenylephrine, 548 (15%) received norepinephrine, 110 (3%) received other single vasopressor, and 923 (25%) received multiple vasopressors. Baseline cervical SCIs, higher Injury Severity Scores, neurogenic shock, and mechanical ventilation were more likely with norepinephrine administration. The primary outcome was death/hospice/skilled nursing facility vs. home/inpatient care facility/rehabilitation facility. Compared with the phenylephrine group, the norepinephrine group was more likely to have a discharge disposition of death/hospice/or skilled nursing facility (odds ratio [OR], 1.50; 95% CI, 1.14-1.99), and adverse events, including urinary tract infections (OR, 1.66; 95% CI, 1.17-2.35), cardiac arrest (OR, 2.70; 95% CI, 1.74-4.19), acute kidney injury (OR, 1.91; 95% CI, 1.32-2.77), tracheostomy (OR, 1.39; 95% CI, 1.04-1.86), death (OR, 2.04; 95% CI, 1.42-2.93), and longer hospital length of stay (estimate, 3.68 d; 95% CI, 1.63-5.74 d). We observed no differences in pneumonia, thromboembolic events, or cerebrovascular accidents.

Conclusions: Phenylephrine and norepinephrine were the most used vasopressors in SCI patients, with norepinephrine more frequently selected in patients with higher injury severity. While indication bias and residual confounding may explain our findings, these data raise the question whether phenylephrine and norepinephrine have different efficacy and safety profiles. Future research should focus on comparative trials of these two commonly prescribed agents.

急性外伤性脊髓损伤危重患者早期血管加压药的应用:一项回顾性队列研究。
目的:关于血管加压药支持急性脊髓损伤(SCI)的证据缺乏。我们报道脊髓损伤患者早期血管加压药的使用和住院结果。设计:倾向评分标准化死亡率加权回顾性队列研究。背景:参与Premier Healthcare Database的美国医院,2016-2020。患者:18岁及以上的成人急性创伤性脊髓损伤T8级或以上,并在住院48小时内接受血管加压药物治疗。干预措施:没有。测量和主要结果:纳入3636例患者(平均[sd]年龄56岁;2757例(75%)男性),2055例(57%)接受苯肾上腺素治疗,548例(15%)接受去甲肾上腺素治疗,110例(3%)接受其他单一血管加压药物治疗,923例(25%)接受多种血管加压药物治疗。基线颈椎SCIs,较高的损伤严重程度评分,神经源性休克和机械通气更可能与去甲肾上腺素给药。主要结局是死亡/临终关怀/专业护理机构vs.家庭/住院护理机构/康复机构。与phenylephrine组相比,去甲肾上腺素组更有可能有死亡/临终关怀/或熟练护理机构的出院处置(优势比[or], 1.50;95% CI, 1.14-1.99),以及不良事件,包括尿路感染(OR, 1.66;95% CI, 1.17-2.35),心脏骤停(OR, 2.70;95% CI, 1.74-4.19),急性肾损伤(OR, 1.91;95% CI, 1.32-2.77),气管切开术(OR, 1.39;95% CI, 1.04-1.86),死亡(OR, 2.04;95% CI, 1.42-2.93)和更长的住院时间(估计,3.68 d;95% CI, 1.63-5.74 d)。我们观察到肺炎、血栓栓塞事件或脑血管意外没有差异。结论:在脊髓损伤患者中,苯肾上腺素和去甲肾上腺素是使用最多的血管加压药物,在损伤严重程度较高的患者中,去甲肾上腺素的使用频率更高。虽然适应症偏差和残留混淆可以解释我们的发现,但这些数据提出了苯肾上腺素和去甲肾上腺素是否具有不同的疗效和安全性的问题。未来的研究应集中在这两种常用药物的比较试验上。
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来源期刊
Critical Care Medicine
Critical Care Medicine 医学-危重病医学
CiteScore
16.30
自引率
5.70%
发文量
728
审稿时长
2 months
期刊介绍: Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
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