Dosage Errors Bedevil Push-Dose Pressors

Background: The risks of hypotension and associated sequelae are challenges to expert care for seriously ill, hospitalized patients. The use of so-called push-dose pressors (vasopressors [PDPs]) outside of the operating room to manage episodes of hypotension has expanded in contemporary critical care and ED practice. Objective: To evaluate the utility of PDP and discuss relevant issues associated with its deployment. Pertinent Points: (1) Most published literature evaluating PDP notes an increase in blood pressure with all agents, but varies with regard to discussion of adverse events. (2) Most series lack direct comparison of PDP agents for outcomes of safety and efficacy. (3) Agents used as PDPs include epinephrine, phenylephrine, norepinephrine, vasopressin, and ephedrine. These vary considerably in dose, mechanism of action, onset of action, and duration of action. Their use is very often a bridge to definitive infusion, as recent retrospective reviews suggest that 28% to 47% of more...