You are here

Article Text

Article menu
Download PDFPDF
Journal update
Journal update monthly top five
  1. Daniel Horner1,2,
  2. Zosia Bredow1,
  3. Alexander Wood1,
  4. Graham Clarke1,
  5. Paul Burgess1,
  6. Oliver Hill1,
  7. Claire Baldwin3,
  8. Daniel Darbyshire4
  1. 1 Emergency Department, Northern Care Alliance NHS Foundation Trust, Salford, UK
  2. 2 Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
  3. 3 Major Trauma Department, Northern Care Alliance NHS Foundation Trust, Salford, UK
  4. 4 Lancaster Medical School, Lancaster University, Lancaster, UK
  1. Correspondence to Professor Daniel Horner, Emergency Department, Northern Care Alliance NHS Foundation Trust, Salford, UK; daniel.horner{at}nca.nhs.uk

https://doi.org/10.1136/emermed-2024-214256

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Introduction

    This month’s update is from the Emergency and Major Trauma Departments at Salford Care Organisation, within the Northern Care Alliance NHS Foundation Trust. We used a multimodal search strategy, drawing on free open-access medical education resources and focused literature searches. We identified the five most interesting and relevant papers (decided by consensus, with editorial oversight) and highlight the main findings, key limitations and clinical bottom line for each paper.

    The papers are ranked as:

    • Worth a peek—interesting, but not yet ready for prime time.

    • Head turner—new concepts.

    • Game changer—this paper could/should change practice.

    Use and outcomes of peripheral vasopressors in early sepsis-induced hypotension across Michigan hospitals by Munroe et al

    Topic: sepsis

    Rating: head turner

    Vasoconstricting drugs (vasopressors) used for sepsis-induced hypotension are traditionally administered by infusion via central venous catheter, due to concerns regarding peripheral extravasation. This retrospective cohort study evaluated the routine use of peripheral vasopressors across 29 hospitals in Michigan between November 2020 and September 2022. 594 patients with early sepsis-induced hypotension received vasopressors within 6 hours of hospital arrival. Over half (67.3%) had vasopressors initiated via peripheral intravenous access.1

    Vasopressors were commenced slightly faster when initiated via peripheral route (median 2.5 hours vs 2.7 hours, p=0.002) and one-third of patients receiving peripheral vasopressors avoided central line insertion altogether. No patients experienced necrosis or tissue ischaemia while receiving peripheral vasopressors. No independent association was found between peripheral or central vasopressor initiation and in-hospital mortality (32.3% vs 42.2%, respectively, adjusted OR 0.66; 95% CI 0.39 to 1.12).

    Limitations of this study include the retrospective cohort design, non-standardisation of vasopressor agents and the influence of specific hospitals on preference for a selected route of administration, highlighting the wide variation in practice. This raises concerns regarding selection bias and potential under-reporting of complications, limiting generalisability.

    Bottom line

    Peripheral initiation of vasopressor agents in sepsis-induced hypotension may confer practical and safety advantages, but further controlled trial evidence is required.

    Serum S100B level in the management of paediatric minor head trauma by Bouvier et al

    Topic: paediatric …

    View Full Text

    Footnotes

    • X @rcemprof, @ClaireB82021905

    • Contributors DH and DD conducted the original search. All authors helped identify appropriate papers for selection. All authors contributed to content development, drafting and revision of the manuscript. DH acts as the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.