Efficacy of Bolus-dose Phenylephrine for Peri-intubation Hypotension

Panchal, Ashish R.; Satyanarayan, Arthi; Bahadir, Jenna D.; Hays, Daniel P.; Mosier, Jarrod

doi:10.1016/j.jemermed.2015.04.033

Cited by 48 publications

(38 citation statements)

References 17 publications

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“…We observed a significant reduction in the incidence of hypotension between pre‐ and postintervention cohorts. Interventions aimed at reducing the frequency of hypotension were components of the preintubation checklist, and included preloading patients at risk of hypotension with fluid bolus therapy, starting an inotrope or vasopressor infusion for persisting circulatory failure despite fluid bolus therapy, having a “rescue” dose of inotrope drawn up prior to induction of anesthesia, and titrating the dose of induction agent to the patients physiology . Induction agent choice and dose were left at the discretion of the treating team.…”

Section: Discussionmentioning

confidence: 99%

A quality improvement initiative to increase the safety of pediatric emergency airway management

Long

Cincotta

Grindlay

et al. 2017

Pediatric Anesthesia

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Section: Discussionmentioning

confidence: 99%

A quality improvement initiative to increase the safety of pediatric emergency airway management

Long

Cincotta

Grindlay

et al. 2017

Pediatric Anesthesia

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“…There have been preliminary attempts at uncovering whether complications can be reduced by treating hypotension during the intubation period. Panchal et al retrospectively evaluated the use of bolus-dose phenylephrine in ED patients and found that patients given a bolus dose of phenylephrine in the peri-intubation period had higher systolic and diastolic blood pressure than those who did not (11). However, they were not able to evaluate the effect on mortality or other relevant outcomes due to confounding factors and a small sample size (11).…”

Section: Discussionmentioning

confidence: 99%

“…Panchal et al retrospectively evaluated the use of bolus-dose phenylephrine in ED patients and found that patients given a bolus dose of phenylephrine in the peri-intubation period had higher systolic and diastolic blood pressure than those who did not (11). However, they were not able to evaluate the effect on mortality or other relevant outcomes due to confounding factors and a small sample size (11). Jaber et al attempted to address whether intubation-related hypotension, and other intubation-related complications could be reduced in a before-and-after interventional trial (12).…”

Section: Discussionmentioning

confidence: 99%

Acute Respiratory Compromise in the Emergency Department: A Description and Analysis of 3571 Events from the Get With the Guidelines–Resuscitation ® Registry

Karlsson

Donnino

Kirkegaard

et al. 2017

The Journal of Emergency Medicine

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Background Respiratory events requiring the use of assisted ventilation are relatively common in the emergency department (ED), and can be associated with substantial morbidity and mortality. Objective The aim of this study was to describe and elucidate patient and event characteristics associated with mortality and progression to cardiac arrest in ED patients with acute respiratory compromise. Methods Data were obtained from the multi-center Get With the Guidelines–Resuscitation® registry. We included patients with acute respiratory compromise defined as absent, agonal, or inadequate respiration that required emergency assisted ventilation. All adult patients between January 2005 and December 2014 with an index event in the ED were included. We used multivariable logistic regression models to assess the association between patient and event characteristics and in-hospital mortality, with cardiac arrest during the event as a secondary outcome. Results A total of 3571 events were included. The in-hospital mortality was 34%. Twelve percent of events progressed to cardiac arrest, with a subsequent 82% in-hospital mortality. When adjusting for patient and event characteristics, we found no temporal changes in in-hospital mortality from 2005 to 2014. Several characteristics were associated with increased mortality, such as pre-event hypotension, septicemia, and acute stroke. Similarly, multiple characteristics, including pre-event hypotension, were associated with progression to cardiac arrest. Conclusions Patient with acute respiratory compromise in the ED had an in-hospital mortality of 34% in the current study. These patients also have a high risk of progressing to cardiac arrest, with a subsequent increase in in-hospital mortality to 82%. Potentially reversible characteristics, such as hypotension before the event, showed a strong association to in-hospital mortality, along with multiple other patient and event characteristics.

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“…The few articles that comprise this literature base address significant hypotension in periendotracheal intubation intervention, postreturn of spontaneous circulation (ROSC) management, and shock management with preload augmentation. [7][8][9] In addition, there are several articles in the literature that address safety concerns surrounding the use of PDP in the ED. 4,5 Panchal et al 10 investigated the use of phenylephrine in hypotensive patients undergoing RSI-assisted endotracheal intubation.…”

Section: Emergency Medicine Literaturementioning

confidence: 99%

“…[7][8][9] In addition, there are several articles in the literature that address safety concerns surrounding the use of PDP in the ED. 4,5 Panchal et al 10 investigated the use of phenylephrine in hypotensive patients undergoing RSI-assisted endotracheal intubation. The authors performed a 1-year retrospective review of hypotensive patients managed with endotracheal intubation for a range of clinical conditions that required clinical care intervention.…”

Section: Emergency Medicine Literaturementioning

confidence: 99%