Push-Dose Pressors Outside the Operating Room: Systematic Review and Meta-Analysis of Observational Studies

Area of Science:

• Critical Care Medicine
• Pharmacology
• Clinical Research

Background:

• Push-dose pressors (PDP) are primarily studied in operating room (OR) patients.
• Evidence for PDP use in critically ill patients outside the OR is limited.
• Safety concerns and logistical challenges make PDP controversial in this population.

Purpose of the Study:

• To systematically review the benefits and risks of using PDP in critically ill patients outside the OR.
• To evaluate the efficacy, safety, and prognostic outcomes of PDP.
• To compare different vasopressor strategies in this patient group.

Main Methods:

• Systematic review of observational studies conducted outside the OR.
• Random-effects meta-analysis of efficacy, safety, and prognostic outcomes.
• Risk of bias assessment using the Newcastle-Ottawa Scale (NOS).

Main Results:

• Nineteen studies with 5034 patients were included.
• PDP corrected hypotension in 77.9% of patients, increasing systolic blood pressure by 30 mm Hg.
• Adverse effects occurred in 14.4% and serious adverse effects in 1.36%; protocol use showed a trend towards reduced risk.

Conclusions:

• PDP is effective for transient hypotension in critical patients outside the OR.
• Protocol use may mitigate safety risks associated with PDP.
• Further clinical trials are necessary to guide current practice.