Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/21891
Title: Initiation of vasopressor infusions via peripheral versus central access in patients with early septic shock: A retrospective cohort study.
Authors: Delaney, Anthony;Finnis, Mark;Bellomo, Rinaldo;Udy, Andrew;Jones, Daryl A;Keijzers, Gerben;MacDonald, Stephen;Peake, Sandra
Affiliation: Intensive Care Unit, The Queen Elizabeth Hospital, Adelaide, Western Australia, Australia
Emergency Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
School of Medicine, Bond University, Gold Coast, Queensland, Australia
School of Medicine, Griffith University, Gold Coast, Queensland, Australia
Emergency Department, Royal Perth Hospital, The University of Western Australia, Perth, Western Australia, Australia
Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
Division of Critical Care, The George Institute for Global Health, Sydney, New South Wales, Australia
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Intensive Care Unit, Austin Health, Heidelberg, Victoria, Australia
Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
Issue Date: 9-Oct-2019
EDate: 2019-10-09
Citation: Emergency medicine Australasia : EMA 2019; online first: 9 October
Abstract: To assess whether the initiation of vasopressor infusions via peripheral venous catheters (PVC) compared to central venous catheters (CVC) in ED patients with early septic shock was associated with differences in processes of care and outcomes. We conducted a post-hoc analysis of the ARISE trial. We compared participants who had a vasopressor infusion first commenced via a PVC versus a CVC. The primary outcome was 90 day mortality. We studied 937 participants. Of these, 389 (42%) had early vasopressor infusion commenced via a PVC and 548 (58%) via a CVC. Trial participants who received a vasopressor infusion via a PVC were more severely ill, with higher median (interquartile range [IQR]) Acute Physiology And Chronic Health Evaluation (APACHE II) scores (17 [13-23] versus 16 [12-21], P = 0.003), and higher median (IQR) lactate (mmol/L) (3.6 [1.9-5.8] versus 2.5 [1.5-4.5], P < 0.001). After adjusting for baseline covariates, the estimated odds ratio for mortality for PVC-treated patients was 1.26 (95% confidence interval 0.95-1.67, P = 0.11). Trial participants who had vasopressors commenced via PVC had a shorter median (IQR) time to commencement of antimicrobials (55 [32-96] versus 71.5 [39-119] min, P < 0.001) and a shorter median (IQR) time to commencement of vasopressors (2.4 [1.3-3.9] versus 4.9 [3.5-6.6] h, P < 0.001). The practice of commencing a vasopressor infusion via a PVC was common in the ARISE trial and more frequent in trial participants with higher severity of illness. Commencement of a vasopressor infusion via a PVC was associated with some improvements in processes of care and, after adjustment, was not associated with an increased risk of death.
URI: http://ahro.austin.org.au/austinjspui/handle/1/21891
DOI: 10.1111/1742-6723.13394
ORCID: 0000-0002-1015-7146
0000-0002-6284-2022
0000-0001-9921-4620
0000-0002-1650-8939
PubMed URL: 31599084
Type: Journal Article
Subjects: central venous catheter
peripheral catheter
resuscitation
septic shock
vasopressors
Appears in Collections:Journal articles

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