Use and Outcomes of Peripheral Vasopressors in Early Sepsis-Induced Hypotension Across Michigan Hospitals: A Retrospective Cohort Study

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BACKGROUND: Vasopressors are traditionally administered via central access, but newer data suggest peripheral administration may be safe and avoid delays and complications associated with central line placement.

RESEARCH QUESTION: How commonly are vasopressors initiated through peripheral IVs in routine practice? Is vasopressor initiation route associated with in-hospital mortality?

STUDY DESIGN AND METHODS: This retrospective cohort study included adults hospitalized with sepsis (11/2020-9/2022) at 29 hospitals in the Michigan Hospital Medicine Safety Consortium, a Collaborative Quality Initiative sponsored by Blue Cross Blue Shield of Michigan. We assessed route of early vasopressor initiation, factors and outcomes associated with peripheral initiation, and timing of central line placement.

RESULTS: 594 patients received vasopressors within 6 hours of hospital arrival and were included in this study. Peripheral vasopressor initiation was common (400/594, 67.3%). Patients with peripheral vs central initiation were similar; body mass index was the only patient factor independently associated with initiation route (aOR of peripheral initiation [per 1 kg/m(2) increase]: 0.98, 95%CI: 0.97-1.00, p=0.015). Hospital had a large impact on initiation route (median OR: 2.19, 95%CI: 1.31-3.07). Compared to central, peripheral initiation was faster (median 2.5 vs 2.7 hours from hospital arrival, p=0.002) but associated with less initial norepinephrine use (84.3% vs 96.8%, p=0.001). We found no independent association between initiation route and in-hospital mortality (32.3% vs 42.2%, aOR 0.66, 95%CI: 0.39-1.12). There was no documented tissue injury from peripheral vasopressors. Of patients with peripheral initiation, 135/400 (33.8%) never had a central line placed.

INTERPRETATION: Peripheral vasopressor initiation was common across Michigan hospitals and had practical benefits, including expedited vasopressor administration and avoidance of central line placement in one-third of patients. However, there was wide practice variation not explained by patient case-mix and lower use of first-line norepinephrine with peripheral administration, suggesting additional standardization may be needed.

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ePub ahead of print