Peri-Intubation Push Dose Vasopressors in Critical Care Transport

Introduction

Push dose vasopressors are administered to attenuate peri-intubation hypotension in critically ill patients. The benefit of push dose vasopressors over initiation of continuous vasopressor infusions is unclear. The aim of this study was to describe current use of push dose vasopressors in critical care transport.

Methods

This was a retrospective chart review of adult patients (≥18 years) intubated between January 2017 and May 2023 by a single critical care transport service who received peri-intubation push dose vasopressors. The primary outcome was incidence of push dose vasopressor administration. The secondary outcome was frequency of initiation or increase in continuous vasopressor infusion after intubation.

Results

Three hundred thirty-four patients were intubated during this period, 49 (14.7%) received push dose vasopressors in the peri-intubation period. The mean age was 55.8 ± 19.7 years and 28 (57.1%) were male. Forty-five (91.8%) were transported via rotor wing aircraft. Twenty-three (46.9%) were scene transports. The most common indication for intubation was trauma (n=30, 61.2%). The mean pre-intubation shock index was 1.1 ± 0.5. Of those who received push dose vasopressors, 34 (69.4%) received multiple push doses; the mean number of administrations was 2.5 ± 1.9. Forty-eight (97.9%) received push dose vasopressors prior to intubation and 36 (73.4%) received push doses post intubation. Fifteen (30.6%) were started on a continuous vasopressor infusion and 3 (11.1%) had an increase in an existing infusion post-intubation.

Conclusion

Push dose vasopressors were utilized in a heterogeneous manner in the peri-intubation period. It remains unclear which patients may benefit from initiation of continuous vasopressor infusion rather than push dose vasopressors. Further investigation is required to better elucidate the role of push dose and continuous vasopressors in the peri-intubation period.