Champ 6. Sécurisation des procédures « circulatoires » (administration des substances vasoactives, utilisation des cathéters artériels, veineux centraux et artériels pulmonaires)

Monnet, Xavier; Lefrant, Jean‐Yves; Teboul, Jean‐Louis

doi:10.1016/j.annfar.2008.09.012

Cited by 19 publications

(4 citation statements)

References 65 publications

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“…Similar to all other vasoconstrictors, norepinephrine has a short half-life. These features require intravenous administration at a constant flow rate, which can be achieved using a high-precision power infusion pump [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Automatic versus manual changeovers of norepinephrine infusion pumps in critically ill adults: a prospective controlled study

Greau

Lascarrou

Thuaut

et al. 2015

Ann. Intensive Care

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BackgroundNorepinephrine is a key drug for treating shock but has a short half-life that requires continuous intravenous administration to maintain the constant plasma concentration needed to obtain a stable blood pressure. The small volume of the syringes used in power infusion pumps requires frequent changeovers, which can lead to norepinephrine flow interruptions responsible for hemodynamic instability. Changeovers from the nearly empty to the full syringe can be performed manually using the quick change technique (QC) or automatically using smart infusion pumps (SIP) that link two syringes. The purpose of our study was to evaluate the hypothesis that, compared to QC, SIP for norepinephrine changeovers was associated with less hemodynamic instability.MethodsAfter information of the patient or next of kin, patients receiving norepinephrine for shock were allocated to QC or SIP changeovers. QC changeovers were performed by a nurse, who started a new loaded pump when the previous syringe was nearly empty. SIP changeovers were managed automatically by SIP workstations. The primary outcome was the proportion of changeovers followed by a ≥20 % drop in mean arterial pressure (MAP).Results411 changeovers were performed, 193 in the 18 patients allocated to QC and 218 in the 32 patients allocated to SIP. Baseline patient characteristics were similar in both groups. The proportion of changeovers followed by an MAP drop ≥20 % was 12.4 % (24/193) with QC and 5.5 % (12/218) with SIP (P = 0.01). By multivariate analysis, two factors were independently associated with a significantly decreased risk of ≥20 % MAP drops during changeovers, namely, SIP (odds ratio, 0.47; 95 % confidence interval, 0.22–0.98) and norepinephrine dosage >0.5 μg/kg/min (odds ratio, 0.39; 95 % confidence interval, 0.19–0.81).ConclusionsThe risk of MAP drops ≥20 % during changeovers can be significantly diminished using SIPs instead of the QC method.Trial registration: Clinicaltrial.gov NCT 01127152

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Section: Introductionmentioning

confidence: 99%

Automatic versus manual changeovers of norepinephrine infusion pumps in critically ill adults: a prospective controlled study

Greau

Lascarrou

Thuaut

et al. 2015

Ann. Intensive Care

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“…Indeed, when using drugs with a narrow safety margin, slight changes in administrated volumes may lead to substantial hemodynamic changes. This has been observed during syringe changeover [4, 5], and accurate SIPs participate to improve the safety of the medication process [6, 7].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of low-weight versus standard syringe infusion pump devices depending on altitude

Blancher

Repellin

Maignan

et al. 2019

Scand J Trauma Resusc Emerg Med

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Background Intravenous drug infusions in critically ill patients require accurate syringe infusion pumps (SIPs). This is particularly important during transportation of critically ill patients by helicopter emergency medical services (HEMS), where altitude may influence device performance. Because weight is a real concern in HEMS, new low-weight devices are very appealing. The aim of this study was to compare infusion flow rates delivered by low-weight versus standard SIP devices, in the prehospital emergency medicine setting, at different altitudes. Methods We conducted a comparative bench study involving five SIP devices (two standard and three low-weight models) at 300, 1700 and 3000 m altitude. The primary endpoint was the flow rate delivered by SIPs for prespecified values. We used two methods to measure flow. The normative method consisted in measuring weight (method A) and the alternate method consisted in measuring instantaneous flow (method B). Results Using method A, no significant differences were found in median flow rates and interquartile range depending on device and altitude for a prespecified 10-mL/h flow. However, method B showed that low-weight SIPs delivered multiple sequential boluses with substantial variations (1.2–15.8 mL/h) rather than a prespecified continuous 5-mL/h flow. At 1700 m altitude, the interquartile range of delivered flows increased only for low-weight devices ( p for interaction< 0.001). Conclusions Despite satisfactory normative tests, low-weight SIPs deliver discontinuous flow with potential clinical implications for critically ill patients receiving vasoactive drugs. This study also highlights a thus far unknown negative impact of altitude on SIP function. We believe that normative requirements for SIP approval should be revised accordingly.

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“…Unfortunately, ACs often fail before end-of-use leading to blood sampling difficulties or distorted blood pressure with noninterpretable curve. A new AC is therefore necessary, exposing patients to rare but serious complications related to this procedure, as finger ischemia ( 2 ). The prevalence of early AC dysfunction varies across studies, occurring in up to 23% of catheters in the CLEAN study ( 3 ).…”

mentioning

confidence: 99%

Impact of Radial Arterial Location on Catheter Lifetime in ICU Surgical Intensive Care

Marié

Dahyot‐Fizelier²,

Barrau

et al. 2023

Critical Care Explorations

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Champ 6. Sécurisation des procédures « circulatoires » (administration des substances vasoactives, utilisation des cathéters artériels, veineux centraux et artériels pulmonaires)

Cited by 19 publications

References 65 publications

Automatic versus manual changeovers of norepinephrine infusion pumps in critically ill adults: a prospective controlled study

Automatic versus manual changeovers of norepinephrine infusion pumps in critically ill adults: a prospective controlled study

Accuracy of low-weight versus standard syringe infusion pump devices depending on altitude

Impact of Radial Arterial Location on Catheter Lifetime in ICU Surgical Intensive Care

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