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.
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.
期刊介绍:
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