.jpg "Sarah Singer, PharmD photo")
Sarah Singer, PharmD
PGY2 Critical Care Pharmacy Resident
Barnes Jewish Hospital
Saint Louis, MO
Disclosure information not submitted.
Hannah Pope, BCPS, PharmD
Clinical Pharmacy Specialist
Barnes Jewish Hospital, United States
Disclosure information not submitted.
Brian Fuller, MD, MSCI,FCCM
Associate Professor of Anesthesiology and Emergency Medicine
Washington University/Barnes-Jewish Hospital
Saint Louis, MO
Disclosure information not submitted.
Gabrielle Gibson, PharmD, BCCCP, BCPS
Clinical Pharmacy Specialist
Barnes Jewish Hosptial, United States
Disclosure information not submitted.
Title: The Safety and Efficacy of Push Dose Phenylephrine in Critically Ill Adults
Introduction: Push dose vasopressors (PDPs) have been utilized to treat the acute hypotensive period in the critically ill. Due to its onset of approximately one minute, phenylephrine is a commonly administered PDP used to treat transient hypotension. Despite PDP use being common practice, there are minimal data to support their use outside of the OR. Furthermore, phenylephrine administration may result in adverse events such as reflexive bradycardia and reduced cardiac output. This study aims to evaluate the use, safety, and efficacy of push dose phenylephrine in critically ill adults outside of the OR.
Methods: Included patients were at least 18 years old and received at least one dose of phenylephrine from June 2018 to July 2020. Patients were classified as responders or non-responders based on achieving at 25% increase in systolic blood pressure within 60 minutes post-phenylephrine administration. The primary safety outcome was the incidence of hypertension or bradycardia. A multivariable logistic regression model was then utilized to assess predictors of phenylephrine response.
Results: Of the 3175 patients evaluated, 1727 patients with 2041 episodes were included. 1140 and 901 patient episodes resulted in phenylephrine response and non-response, respectively. Non-responders received phenylephrine for acute hypotension associated with rapid sequence intubation more frequently than responders (69.8% versus 62.3%; p< 0.001). Furthermore, responders received continuous vasopressor infusions within 60 minutes of PDP administration more often than non-responders (71.8% versus 49.1%; p< 0.001). Phenylephrine responders were more likely to experience hypertension than non-responders (8.4% versus 2.2%; p< 0.001), however, there was no difference in IV antihypertensive use or bradycardia. Patients that received crystalloid boluses (OR = 0.639, 95% CI 0.432-0.946) or packed red blood cells (OR = 0.303, 95% CI 0.099-0.935) were significantly less likely to respond to phenylephrine administration.
Conclusions: Despite the paucity of available data, phenylephrine is a commonly used PDP to treat acute hypotension outside of the OR. This study further supports that utilizing phenylephrine as a PDP is a safe and efficacious practice.