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Oral Phenylephrine as Adjuvant Therapy for Weaning Intravenous Vasopressors in Septic Shock FREE TO VIEW

Micah Whitson; Edwin Mo; Lauren Healy; Seth Koenig; Mangala Narasimhan; Paul Mayo
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Long Island Jewish Medical Center, New York, NY

Chest. 2015;148(4_MeetingAbstracts):333A. doi:10.1378/chest.2278539
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 26, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Vasopressors are routinely used in the treatment of septic shock, and in most institutions intravenous (IV) vasopressors must be discontinued before transfer from the intensive care unit (ICU). Adjuvant use of oral phenylephrine (PE) may significantly decrease the duration of IV vasopressor use in septic shock, decreasing ICU length of stay (LOS). We describe the use of oral PE for patients on low, stable doses of vasopressors to facilitate IV vasopressor weaning.

METHODS: Retrospective data of patients in a medical ICU in an urban tertiary care center who required IV vasopressors for septic shock was collected over a one year period. Subjects were divided by those who received oral PE as adjuvant therapy and those who received only IV vasopressors. These groups were compared for severity of illness by APACHE IV scores, baseline patient characteristics, and duration of IV vasopressor use. Re-institution of vasopressors after successful weaning, discontinuation of oral PE, or side effects such as end organ dysfunction were also recorded.

RESULTS: 277 patients met study criteria receiving IV norepinephrine, phenylephrine, or both. 137 patients received oral PE while 140 received only IV vasopressors. APACHE scores, etiology of shock, age, and gender were not significantly different between the two groups (APACHE scores: 81.33 vs. 84.04, age: 69 vs. 65 years, male/female ratio: 0.48 vs. 0.55). Mean vasopressor duration was significantly reduced in the oral PE group compared to the IV vasopressor only group (2.9 days vs. 3.8 days, p= 0.004). Vasopressors were also re-instituted after weaning less often in the oral PE group (7 patients vs 11 patients). Oral PE was only discontinued once secondary to bradycardia, and no end organ dysfunction attributable to oral PE was observed.

CONCLUSIONS: The use of oral PE may significantly reduce the duration of IV vasopressors in septic shock allowing more rapid transfer from the ICU. Oral PE may also reduce recurrent use of vasopressors during the hospital admission.

CLINICAL IMPLICATIONS: Critical care utilization is an important issue in the current healthcare environment. Safe measures that will reduce ICU LOS will improve patient outcomes and expand access to specialized care. Further prospective studies are needed to show evidence for the safety and efficacy of oral PE use to aid in IV vasopressor weaning.

DISCLOSURE: The following authors have nothing to disclose: Micah Whitson, Edwin Mo, Lauren Healy, Seth Koenig, Mangala Narasimhan, Paul Mayo

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