Norepinephrine Infusion in the Emergency Department in Septic Shock Patients: A Retrospective 2-Years Safety Report and Outcome Analysis
Open Access
- 19 January 2021
- journal article
- research article
- Published by MDPI AG in International Journal of Environmental Research and Public Health
- Vol. 18 (2), 824
- https://doi.org/10.3390/ijerph18020824
Abstract
Hemodynamic optimization during sepsis and septic shock is based on a prompt and large fluid resuscitation strategy associated with early administration of norepinephrine. In our hospital, norepinephrine is administered in the emergency department (ED), within a protocol-guided management context, to reduce norepinephrine infusion timing due to central line insertion. This choice, however, can be associated with side effects. Objectives: We conducted a retrospective analysis regarding the safety of norepinephrine in the ED. We also appraised the association between in-hospital mortality and predefined ED variables and patients’ admission severity scores. Design, settings, and participants: This was a retrospective analysis of electronic sheets of the ED of a tertiary hospital in the North of Italy. Outcomes measure and analysis: Electronic documentation was assessed to identify local and systemic side effects. We considered two subgroups of patients according to the in-hospital clinical paths: (1) those admitted in the intensive care unit (ICU); and (2) those who received a ceiling of care decision. We collected and considered variables related to septic shock treatment in the ED and analyzed their association with in-hospital mortality. Main Results: We considered a two-year period, including 108,033 ED accesses, and ultimately analyzed data from 127 patients. Side effects related to the use of this drug were reported in five (3.9%) patients. Thirty patients (23.6%) were transferred to the ICU from the ED, of whom six (20.0%) died. Twenty-eight patients (22.0%) received a ceiling of care indication, of whom 21 (75.0%) died. Of the 69 (54.3%) finally discharged to either medical or surgical wards, 21 (30.4%) died. ICU admission was the only variable significantly associated to in-hospital mortality in the multivariable analysis [OR (95% CI) = 4.48 (1.52–13.22); p-value = 0.007]. Conclusions: Norepinephrine peripheral infusion in the ED was associated with a low incidence of adverse events requiring discontinuation (3.9%). It could be considered safe within <12 h when a specific line management protocol and pump infusion protocol are adopted. None of the variables related to septic shock management affected in-hospital mortality, except for the patient’s ICU admission.This publication has 22 references indexed in Scilit:
- Utilization and extravasation of peripheral norepinephrine in the emergency departmentThe American Journal of Emergency Medicine, 2020
- Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease StudyThe Lancet, 2020
- The Surviving Sepsis Campaign Bundle: 2018 updateIntensive Care Medicine, 2018
- Promoting and sustaining a historical and global effort to prevent sepsis: the 2018 World Health Organization SAVE LIVES: Clean Your Hands campaignCritical Care, 2018
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016Intensive Care Medicine, 2017
- Safety of peripheral intravenous administration of vasoactive medicationJournal of Hospital Medicine, 2015
- Sepsis and the HeartJournal of the American College of Cardiology, 2007
- Central venous catheterizationCritical Care Medicine, 2007
- Changeovers of vasoactive drug infusion pumps: impact of a quality improvement programCritical Care, 2007
- Tissue Necrosis Following Subcutaneous Infiltration with Nor-EpinephrineThe New England Journal of Medicine, 1952