Predictors of haemodynamic instability during the changeover of norepinephrine infusion pumps

Abstract

BackgroundChangeovers of norepinephrine infusion pumps (CNIPs) frequently lead to haemodynamic instability. The aim of this study was to identify risk factors for haemodynamic instability associated with CNIP, independent of the method used to perform the relay.MethodsWe performed a prospective study, in a university-affiliated intensive care unit. Over a 1-year period, all adult patients who had at least one CNIP were included. CNIPs were automatically performed using smart pumps, in accordance with a standardised protocol. CNIP-induced haemodynamic instability was defined as a variation in mean arterial pressure (MAP) >25 %. A multivariate mixed effects logistic regression was fitted to assess the factors associated with CNIP-induced haemodynamic instability.ResultsFrom the 118 patients included in the study, 764 CNIPs were analysed. Most of the patients were treated with norepinephrine for septic shock of medical origin (n = 83, 70 %). Haemodynamic instability occurred 114 times (15 %) in 63 patients (53 %). Among the risk factors identified by the univariate analysis (age, heart rate, dose of norepinephrine infused, and change in the concentration of the vasoactive drug; p < 0.05), change in the norepinephrine concentration was the only independent risk factor for CNIP-induced haemodynamic instability identified in the multivariate analysis (adjusted OR 11.8, 95 % CI 7.2–19.5, p < 0.001).ConclusionsChanges in the norepinephrine concentration during CNIPs lead to a high risk of haemodynamic instability, while the clinical severity of patients, as well as the doses of norepinephrine, was not.

Effect of central venous pressure on fluid delivery during start‐up of syringe infusion pumps for microinfusion

“…As an explanation to these clinical findings, Russotto and coworkers argued that central venous pressure may have caused backflow and bolus events during vasopressor syringe changeover independently of the strategy used 24,25 . So far, the CVP level has not been included in studies investigating predictors of hemodynamic instability during changeovers of norepinephrine infusion pumps and certainly needs further alertness and research 26 …”

“…24,25 So far, the CVP level has not been included in studies investigating predictors of hemodynamic instability during changeovers of norepinephrine infusion pumps and certainly needs further alertness and research. 26 Some limitations of this study must be acknowledged. The current study only investigated a single pump assembly attached to a central venous line with stable CVP levels.…”