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Circulatory failures are the main cause of admissions in the intensive care unit. It is recommended to prescribe to these patients an intravenous injection of catecholamine to correct this dysfunction and to keep an hemodynamic stability. Electric pumps are used to administrate a continuous flow of drugs to patient. When a syringe of drugs ends, it is replaced by a full syringe, it is named "relay". This change may cause a flow interruption and hypotension.
In the intensive care unit at departmental hospital (CHD) Vendee, the manual relays used in common practice will cause hemodynamic instabilities : hypotensions in 20% cases. Since 4 years, new devices are also used to make the relays. It is "smart pumps" allowing to manage automated the drug delays. This new method allows to not interrupt the drug flow. It could reduce the occurence of hypotension. A 50% decrease of relative number of hypotension will show that the use of automatic method is the most sure medical strategy.
Our study want to compare manual and automatic method watching the variations of medium arterial pressure (MAP) during the fifteen minutes after the relay compared to baseline (MAP before the relay). Noradrenalin is the catecholamine most administrated so we choose to study only the relay for this drug.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Automatic relays | Active Comparator | Automatic relays of noradrenalin using intensive basis. |
|
| Manual relays | Active Comparator | Relays of noradrenalin using manual method |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Measure of arterial pressure | Procedure | Measure of arterial pressure will occur every five minutes during the thirty minutes before the relay and during the fifteen minutes after the relay. |
| Measure | Description | Time Frame |
|---|---|---|
| Hypotension occurence defined as a decrease of 20% of the medium arterial pressure(MAP) between the baseline (MAP before the relay) and the minimal MAP in the fifteen minutes after the relay. | every five minutes during the thirty minutes before the relay, during the fifteen minutes after the relay |
| Measure | Description | Time Frame |
|---|---|---|
| Number of relays where the medium arterial pressure (MAP) is decreased by 10% compared to baseline | every five minutes during the thirty minutes before the relay, during the fifteen minutes after the relay | |
| Number of relays where the medium arterial pressure (MAP) is inferior to 50 millimeter of mercury (mmHg) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jean Reignier, MD | CHD Vendée | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CHD Vendée | La Roche-sur-Yon | Vendée | 85925 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26577132 | Result | Greau E, Lascarrou JB, Le Thuaut A, Maquigneau N, Alcourt Y, Coutolleau A, Rousseau C, Erragne V, Reignier J. Automatic versus manual changeovers of norepinephrine infusion pumps in critically ill adults: a prospective controlled study. Ann Intensive Care. 2015 Dec;5(1):40. doi: 10.1186/s13613-015-0083-7. Epub 2015 Nov 14. |
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| during the fifteen minutes after the relay |
| Number of hypotension in patients whose dose of noradrenalin is > 0,5 gamma/kg/min | every five minutes during the thirty minutes before the relay, during the fifteen minutes after the relay |
| ID | Term |
|---|---|
| D007022 | Hypotension |
| ID | Term |
|---|---|
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
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