A prospective comparison of peripheral metaraminol versus dilute noradrenaline in the intensive care unit

Ruchti, Vera E.W.; Wibrow, Bradley; Seet, Jason; Jacques, Angela; Jha, Nihar; Anstey, Matthew

doi:10.1177/0310057x20984794

Cited by 3 publications

(5 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The frequency of adverse events with metaraminol has not been clearly established. Both observational studies that we included in the narrative review [33,35] demonstrated, that metaraminol is able to sustain arterial pressure while producing global haemodynamic parameters near identical to those of noradrenaline. The most informative study to date by Natalini et al used the cross-over design in a small group of patients allowing a direct comparison of metaraminol and noradrenaline effects in the same individual.…”

Section: Discussionmentioning

confidence: 99%

“…Thirteen other articles that were excluded [21][22][23][24][25][26][27][28][29][30][31][32], as they did not meet the inclusion criteria. Four were either prospective or retrospective observational studies regarding metaraminol use in combination with other vasopressors, metaraminol dosing, frequency of metaraminol use [21,23,24,33,34]. Four were case reports, highlighting use of metaraminol for shock of different etiologies [22,27,28,31].…”

Section: Narrative Reviewmentioning

confidence: 99%

“…The two remaining studies [33,35] studies focused on different aspects of metaraminol use, rendering any statistical analysis impossible. Natalini et al [35] carried out a prospective cohort analysis aiming to compare the haemodynamic effects of metaraminol and norepinephrine in patients with septic shock.…”

Section: Narrative Reviewmentioning

confidence: 99%

“…No significant changes between effects of metaraminol and norepinephrine were observed. Ruchti et al [33] published a letter on a prospective comparison of peripheral use of metaraminol and diluted norepinephrine. A hundred patient were included in the study without any randomisation.…”

Section: Narrative Reviewmentioning

confidence: 99%

See 3 more Smart Citations

The use of metaraminol as a vasopressor in critically unwell patients: a narrative review and a survey of UK practice

Grauslyte

Bolding

Phull

et al. 2022

The Journal of Critical Care Medicine

View full text Add to dashboard Cite

Background Major international guidelines state that norepinephrine should be used as the first-line vasopressor to achieve adequate blood pressure in patients with hypotension or shock. However, recent observational studies report that in the United Kingdom and Australia, metaraminol is often used as second line medication for cardiovascular support. Aim of the study The aim of this study was to carry out a systematic review of metaraminol use for management of shock in critically unwell patients and carry out a survey evaluating whether UK critical care units use metaraminol and under which circumstances. Methods A systematic review literature search was conducted. A short telephone survey consisting of 6 questions regarding metaraminol use was conducted across 30 UK critical care units which included a mix of tertiary and district general intensive care units. Results Twenty-six of thirty contacted centres responded to our survey. Metaraminol was used in 88% of them in various settings and circumstances (emergency department, theatres, medical emergencies on medical wards), with 67% reporting use of metaraminol infusions in the critical care setting. The systematic literature review revealed several case reports and only two studies conducted in the last 20 years investigating the effect of metaraminol as a stand-alone vasopressor. Both studies focused on different aspects of metaraminol use and the data was incomparable, hence we decided not to perform a meta-analysis. Conclusions Metaraminol is widely used as a vasopressor inside and outside of the critical care setting in the UK despite limited evidence supporting its safety and efficacy for treating shock. Further service evaluation, observational studies and prospective randomised controlled trials are warranted to validate the role and safety profile of metaraminol in the treatment of the critically unwell patient.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Narrative Reviewmentioning

confidence: 99%

Section: Narrative Reviewmentioning

confidence: 99%

Section: Narrative Reviewmentioning

confidence: 99%

See 2 more Smart Citations

The use of metaraminol as a vasopressor in critically unwell patients: a narrative review and a survey of UK practice

Grauslyte

Bolding

Phull

et al. 2022

The Journal of Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…Administration of IV vasopressors may also prolong need for venous and arterial access devices with attendant (albeit low) risks such as bloodstream infection and vasopressor extravasation. [2][3][4] Therefore, there is a need to establish whether patients with persistent hypotension can be liberated from IV vasopressors through the use of alternative, enterally-administered vasopressor agents.…”

Section: Introductionmentioning

confidence: 99%

Oral midodrine does not expedite liberation from protracted vasopressor infusions: A case-control study

Wood

Rauniyar

Jacques

et al. 2022

Anaesth Intensive Care

Self Cite

View full text Add to dashboard Cite

Vasopressor dependence is a common problem affecting patients in the recovery phase of critical illness, often necessitating intensive care unit (ICU) admission and other interventions which carry associated risks. Midodrine is an orally administered vasopressor which is commonly used off-label to expedite weaning from vasopressor infusions and facilitate discharge from ICU. We performed a single-centre, case-control study to assess whether midodrine accelerated liberation from vasopressor infusions in patients who were vasopressor dependent. Cases were identified at the discretion of treating intensivists and received 20 mg oral midodrine every eight h from enrolment. Controls received placebo. Data on duration and dose of vasopressor infusion, haemodynamics and adverse events were collected. Between 2012 and 2019, 42 controls and 19 cases were recruited. Cases had received vasopressor infusions for a median of 94 h versus 29.3 h for controls, indicating prolonged vasopressor dependence amongst cases. Midodrine use in cases was not associated with faster weaning of intravenous (IV) vasopressors (26 h versus 24 h for controls, P = 0.51), ICU or hospital length of stay after adjustment for confounders. Midodrine did not affect mean heart rate but was associated with bradycardia. This case-control study demonstrates that midodrine has limited efficacy in expediting weaning from vasopressor infusions in patients who have already received relatively prolonged courses of these infusions.

show abstract

Peripherally administered vasopressors in critically ill adult patients: A survey of UK healthcare professional practices, attitudes and experiences

Hussain,

Jovaisa,

Puthucheary

et al. 2024

Journal of the Intensive Care Society

View full text Add to dashboard Cite

Background: Peripherally administered vasopressor infusions are used to support critically ill patients. The Intensive Care Society recently published guidelines supporting their use. Preliminary evidence suggests variability in peripheral vasopressor infusion use. We aimed to characterise current practice in the use of peripheral vasopressor infusions in the UK National Health Service and to capture the views of healthcare professionals caring for critically ill adult patients. Method: We conducted an online survey of healthcare professionals from December 2022 to March 2023. Our survey used Google Forms and was shared via email, X (formerly twitter), and mobile phone messaging within the UK. Health Research Authority approval was sought, and ethical approval was not required. Results: We received 227 responses and our survey showed variation in the use of peripherally administered vasopressor infusions in critically ill patients across UK National Health Service hospitals. About 87.7% of healthcare professionals initiated peripheral vasopressor infusions in their clinical role. Peripheral vasopressor use was limited to low dose, short durations of infusions, however, there was variability. Metaraminol was the most used peripheral vasopressor (90.3%). Only 22.5% of healthcare professionals used peripherally administered noradrenaline in practice. Our respondents agreed that equipoise exists. Conclusion: Our survey found variability in the use of peripheral vasopressors and in care delivered to critically ill patients in the UK. Our survey shows there are ongoing concerns regarding safety, dosing ranges and durations of use. Future research is required to explore the optimal role that peripheral vasopressor infusions can play in the care of critically ill patients.

show abstract

A prospective comparison of peripheral metaraminol versus dilute noradrenaline in the intensive care unit

Cited by 3 publications

References 6 publications

The use of metaraminol as a vasopressor in critically unwell patients: a narrative review and a survey of UK practice

The use of metaraminol as a vasopressor in critically unwell patients: a narrative review and a survey of UK practice

Oral midodrine does not expedite liberation from protracted vasopressor infusions: A case-control study

Peripherally administered vasopressors in critically ill adult patients: A survey of UK healthcare professional practices, attitudes and experiences

Contact Info

Product

Resources

About