Comparison of metaraminol versus no metaraminol on time to resolution of shock in critically ill patients.
clinical medicine
critical care
emergency medicine
evidence-based medicine
Journal
European journal of hospital pharmacy : science and practice
ISSN: 2047-9956
Titre abrégé: Eur J Hosp Pharm
Pays: England
ID NLM: 101578294
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
received:
25
08
2021
accepted:
28
09
2021
pmc-release:
01
07
2024
medline:
26
6
2023
pubmed:
9
10
2021
entrez:
8
10
2021
Statut:
ppublish
Résumé
There is limited evidence to support metaraminol use in critically ill patients. Metaraminol is not included as a vasopressor choice in international guidelines for the management of shock. Nevertheless, metaraminol is used in rates up to 42% in this patient population. The objective of this study was to investigate the effectiveness of metaraminol for the treatment of critically ill patients with shock. A single-centre retrospective matched observational study was conducted in a 54-bed intensive care unit of a tertiary hospital. Patients aged 16 years or older who were admitted from 2017 to 2019 with shock were included. Patients treated with metaraminol and norepinephrine (MET-NOR) were compared with those treated with norepinephrine without metaraminol (NOR). The primary outcome was the time to resolution of shock defined as the time to cessation of vasopressors. The secondary outcome was vasopressor-free days until 28 days. There were 286 patients included in this study, including 143 patients in each group. The median time to resolution of shock was 44 hours (IQR 28-66 hours) in the MET-NOR group compared with 27 hours (IQR 14-63 hours) in the NOR group (95% CI of median difference 7 to 19 hours; p<0.01). The Cox regression analysis for the time to resolution of shock showed no significant difference between groups (HR 1.24, 95% CI 0.96 to 1.60; p=0.10). However, the proportional hazards assumption was not met (p<0.01). The median number of vasopressor-free days until 28 days was 26 days (IQR 24-27 days) in the MET-NOR group compared with 27 days (IQR 25-27 days) in the NOR group (95% CI of median difference -0.8 to -0.1 day; p<0.01). In critically ill patients, metaraminol may be associated with a longer time to resolution of shock compared with those who do not receive metaraminol.
Identifiants
pubmed: 34620686
pii: ejhpharm-2021-003035
doi: 10.1136/ejhpharm-2021-003035
pmc: PMC10359804
doi:
Substances chimiques
Metaraminol
818U2PZ2EH
Vasoconstrictor Agents
0
Norepinephrine
X4W3ENH1CV
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
214-220Informations de copyright
© European Association of Hospital Pharmacists 2023. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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