米国におけるノレピネフリン不足と死因の関連性
Emily Vail1, Hayley B Gershengorn2, May Hua3
1Department of Anesthesiology, Columbia University, New York, New York.
JAMA
|March 22, 2017
まとめ
薬の不足は 2011年のノレピネフリン不足のように 患者の死亡率の増加と関連しています 欠乏期にはフェニルエフリンが一般的な代替薬でしたが 性ショック患者では 結果が悪化しました
科学分野:
- クリティカル ケア 医療
- 薬理学について
- 健康 成果 研究
背景:
- 薬の不足は米国で懸念が高まっており,医療の提供に影響しています.
- 薬の不足が患者に与える臨床的影響は,特に重症病棟ではあまり報告されていません.
- ノルエピネフリンは 性ショックの管理に不可欠な第一線血管圧縮剤です
研究 の 目的:
- 2011年の全国的なノレピネフリン不足が患者のケアと成果に与える影響を調査する.
- 短期間中に血管圧縮剤の使用と入院死亡率の変化を評価する.
- ノルエピネフリンが不足しているときに使用される代替血管圧縮剤を特定する.
主な方法:
- "プレミア・ヘルスケア・データベース"を利用した遡及的なコホート研究
- セプティックショック患者におけるノルエピネフリン使用率が少なくとも60%であった米国の26の病院を含む (n=27,835).
- ノルエピネフリン使用,代替的血管圧縮剤投与 (主にフェニルエフリン) と,多層混合効果のロジスティック回帰を用いた入院死亡率の分析.
主要な成果:
- ノルエピネフリンの使用は2011年の不足で著しく減少し,フェニルエフリンは最も頻繁な代替品となりました.
- 短期間に入院した患者は,通常の使用期間に入院した患者 (35. 9%) と比べて,入院死亡率が高かった.
- 死亡率の絶対リスク増加は3. 7%で,短縮期に関連した調整された確率比は1. 15 (P=0. 03) であった.
結論:
- 2011年の米国病院におけるノレピネフリン不足は,感染ショックを受けた患者の病院内死亡率の増加と関連していました.
- フェニルエフリンは主たる代替血管圧縮剤でしたが,その使用は死亡率の上昇を軽減しませんでした.
- 検査結果は,セプティックショックのような重篤な状態における患者の治療結果に 薬の利用可能性が及ぼす重大な影響を強調しています.
関連する概念動画
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
1.1K
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
1.1K
01:30Adrenergic Agonists: Therapeutic Uses
2.1K
Adrenergic agonists have diverse therapeutic uses across various medical conditions and emergencies.
Emergency and Intensive Care Unit (ICU) applications: Pressor agents increase blood pressure, heart rate, and contractility in shock and organ failure situations. Dopamine can induce vasodilation and stimulate adrenoceptors. Endogenous catecholamines are effective in treating cardiogenic shock. α2-agonists like clonidine can reverse anesthesia-induced hypertension.
Allergies and...
Emergency and Intensive Care Unit (ICU) applications: Pressor agents increase blood pressure, heart rate, and contractility in shock and organ failure situations. Dopamine can induce vasodilation and stimulate adrenoceptors. Endogenous catecholamines are effective in treating cardiogenic shock. α2-agonists like clonidine can reverse anesthesia-induced hypertension.
Allergies and...
2.1K
01:21Drugs Affecting Neurotransmitter Release or Uptake
1.7K
Certain drugs can affect how neurotransmitters called catecholamines, are released or taken back up in the adrenergic neuron. They can have different effects on the body's sympathetic transmission. Reserpine, a natural compound found in the Rauwolfia shrub, blocks a transporter called vesicular monoamine transporter (VMAT), which leads to a buildup of catecholamines in the cell and reduces sympathetic transmission. Another drug called guanethidine works in multiple ways, including blocking...
1.7K
01:24Blood Pressure Imbalances and Circulatory Shock
1.8K
Disorders affecting blood volume, vascular tone, or vascular function can disrupt vascular homeostasis, including conditions like hypertension, hemorrhage, and shock.
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
1.8K
01:26Acute Coronary Syndrome V: Nursing Management
426
Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
426
01:29Heart Failure II: Pathophysiology
1.2K
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
1.2K