• Andrew Rotando, Lindsey Picard, Samantha Delibert, Karin Chase, Jones Courtney M C CMC Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 655, Rochester, NY 14642, United States of America., and Nicole M Acquisto.
• Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 655, Rochester, NY 14642, United States of America.
• Am J Emerg Med. 2019 Mar 1; 37 (3): 494-498.

PurposeEvaluate push dose vasopressor (PDP) practice patterns, efficacy, and safety in critically ill patients.MethodsCritically ill patients receiving phenylephrine or ephedrine PDP from November 2015-March 2017 were included. Patient demographics, medication administration details, vital signs pre- and post-administration, adverse effects, and medications errors were collected. Descriptive data are presented and comparisons were made with paired samples t-test, Wilcoxon Rank Sum and Chi-squared analysis or Fisher's Exact Test as appropriate.ResultsA total of 146 patients (155 PDP events) were included; mean age 64.5 ± 13.3 years and 66.4% males, respiratory failure (39.8%) or sepsis (24.9%) admission diagnosis. The surgical intensive care unit (ICU) (44.5%) and medical ICU (33.6%) used PDPs most often, and during the peri-intubation period (57.3%) or for other transient hypotension (38.2%). Following PDP, mean systolic blood pressure (BP), diastolic BP, and heart rate (HR) increased 32.5% (80 to 106 mmHg), 27.2% (48 to 61 mmHg), and 6.4% (93 to 99 bpm), respectively. There were 17 (11.6%) adverse events; most often related to excessive increases in BP or HR and one incidence of dysrhythmia. Thirteen patients (11.2%) had a dose related medication error (phenylephrine dose >200 μg or ephedrine dose >25 mg), nine (6.2%) received PDP with normal/elevated hemodynamics (systolic BP > 100 mmHg or HR > 160 bpm) and 15% while on a continuous infusion vasopressor.ConclusionPDPs were used in a variety of patient diagnoses and for select indications. Overall, they were efficacious but associated with adverse drug events and medication errors.Copyright © 2018 Elsevier Inc. All rights reserved.

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