{"id":25573,"date":"2024-04-17T04:10:00","date_gmt":"2024-04-16T20:10:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=25573"},"modified":"2024-04-17T05:24:55","modified_gmt":"2024-04-16T21:24:55","slug":"chest%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%a4%96%e5%91%a8%e9%9d%99%e8%84%89%e8%be%93%e6%b3%a8%e5%8e%bb%e7%94%b2%e8%82%be%e4%b8%8a%e8%85%ba%e7%b4%a0","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=25573","title":{"rendered":"[Chest\u53d1\u8868\u8bba\u6587]\uff1a\u5916\u5468\u9759\u8109\u8f93\u6ce8\u53bb\u7532\u80be\u4e0a\u817a\u7d20"},"content":{"rendered":"\n<p>CRITICAL CARE: ORIGINAL RESEARCH|<a href=\"https:\/\/journal.chestnet.org\/issue\/S0012-3692(23)X0004-X\">\u00a0VOLUME 165, ISSUE 2<\/a>,\u00a0P348-355,\u00a0FEBRUARY 2024<\/p>\n\n\n\n<h1 class=\"wp-block-heading\">Peripheral Administration of Norepinephrine: A Prospective Observational Study<\/h1>\n\n\n\n<h3 class=\"wp-block-heading\">Jason R. Yerke, Eduardo Mireles-Cabodevila, Alyssa Y. Chen, et al<\/h3>\n\n\n\n<h3 class=\"wp-block-heading\">Chest 2024; 165: 348-355 Published:August 20, 2023 DOI:<a href=\"https:\/\/doi.org\/10.1016\/j.chest.2023.08.019\">https:\/\/doi.org\/10.1016\/j.chest.2023.08.019<\/a><\/h3>\n\n\n\n<h3 class=\"wp-block-heading\">Background<\/h3>\n\n\n\n<p>Historically, norepinephrine has been administered through a central venous catheter (CVC) because of concerns about the risk of ischemic tissue injury if extravasation from a peripheral IV catheter (PIVC) occurs. Recently, several reports have suggested that peripheral administration of norepinephrine may be safe.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Research Question<\/h3>\n\n\n\n<p>Can a protocol for peripheral norepinephrine administration safely reduce the number of days a CVC is in use and frequency of CVC placement?<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Study Design and Methods<\/h3>\n\n\n\n<p>This was a prospective observational cohort study conducted in the medical ICU at a quaternary care academic medical center. A protocol for peripheral norepinephrine administration was developed and implemented in the medical ICU at the study site. The protocol was recommended for use in patients who met prespecified criteria, but was used at the treating clinician\u2019s discretion. All adult patients admitted to the medical ICU receiving norepinephrine through a PIVC from February 2019 through June 2021 were included.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Results<\/h3>\n\n\n\n<p>The primary outcome was the number of days of CVC use that were avoided per patient, and the secondary safety outcomes included the incidence of extravasation events. Six hundred thirty-five patients received peripherally administered norepinephrine. The median number of CVC days avoided per patient was 1 (interquartile range, 0-2\u00a0days per patient). Of the 603 patients who received norepinephrine peripherally as the first norepinephrine exposure, 311 patients (51.6%) never required CVC insertion. Extravasation of norepinephrine occurred in 35 patients (75.8 events\/1,000\u00a0d of PIVC infusion [95%\u00a0CI, 52.8-105.4 events\/1,000\u00a0d of PIVC infusion]). Most extravasations caused no or minimal tissue injury. No patient required surgical intervention.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/ars.els-cdn.com\/content\/image\/1-s2.0-S0012369223053503-ga1_lrg.jpg\" alt=\"\"\/><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Interpretation<\/h3>\n\n\n\n<p>This study suggests that implementing a protocol for peripheral administration of norepinephrine safely can avoid 1 CVC day in the average patient, with 51.6%\u00a0of patients not requiring CVC insertion. No patient experienced significant ischemic tissue injury with the protocol used. These data support performance of a randomized, prospective, multicenter study to characterize the net benefits of peripheral norepinephrine administration compared with norepinephrine administration through a CVC.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>CRITICAL CARE: ORIGINAL RESEARCH|\u00a0VOLUME 165, ISSUE 2,\u00a0 [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25573"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25573"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25573\/revisions"}],"predecessor-version":[{"id":25574,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25573\/revisions\/25574"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25573"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25573"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25573"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}