title: Efficacy of Bolus-dose Phenylephrine for Peri-intubation Hypotension.
abstract: BACKGROUND
  Intubation in hypotensive emergency department (ED) patients may increase the risk of life-threatening complications such as hypoperfusion and cardiovascular collapse. Peripherally administered, diluted "push-dose" phenylephrine has been advocated to treat peri-intubation hypotension, however, its effectiveness is unknown.
  
  
  OBJECTIVE
  To investigate the efficacy and usage patterns of bolus-dose phenylephrine for peri-intubation hypotension at an academic medical center.
  
  
  METHODS
  A retrospective chart review of all adult intubated, hypotensive patients (systolic blood pressure [SBP] < 90 mm Hg) over 12 months was conducted. During the peri-intubation period (30-min prior to/after intubation), the effect of phenylephrine was evaluated pre/post drug administration by comparing SBP, diastolic blood pressure (DBP), and heart rate (HR).
  
  
  RESULTS
  A total of 119 patients met eligibility criteria. Phenylephrine was given to 29/119 (24%) patients and 20 (17%) were treated during the peri-intubation period. Phenylephrine was given for many different conditions, and treatment timing varied greatly. Phenylephrine was given with other vasopressors 70% of the time (14/20), however, the timing of vasopressor infusion also varied greatly. When phenylephrine was given during the peri-intubation period, there were significant increases in SBP and DBP (p < 0.01) with no change in HR.
  
  
  CONCLUSIONS
  In this academic ED, bolus-dose phenylephrine was used by practitioners without a systematic pattern. Although phenylephrine improved hemodynamics, it is possible that nonsystematic use of phenylephrine may cause inadvertent negative effects. Further studies will need to be conducted to better understand the best practices for use of phenylephrine.
authors.affiliation: Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Ashish R
authors.initials: AR
authors.lastname: Panchal
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Arthi
authors.initials: A
authors.lastname: Satyanarayan
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Jenna D
authors.initials: JD
authors.lastname: Bahadir
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hays
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Jarrod
authors.initials: J
authors.lastname: Mosier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000503:physiopathology; D007440:Intubation; D008297:Male; D008875:Middle Aged; D010656:Phenylephrine / Q000008:administration & dosage*; D012189:Retrospective Studies; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents; D010656:Phenylephrine
keywords: hypotension; peri-intubation; phenylephrine; sepsis; shock; vasopressors