Abstract：
OBJECTIVE: Norepinephrine is available commercially in solution containing its salt (eg, tartrate), but only the base form (ie, norepinephrine base) is active pharmacologically. Unfortunately, the outer label of drug packages frequently reports the dosage of norepinephrine as a salt, which can lead potentially to therapeutic errors when prescribing norepinephrine. We performed a survey to assess the level of awareness of this issue.
METHODS: National survey.
METHODS: Acute care units of Italian hospitals.
METHODS: Acute care physicians and nurses.
METHODS: A 15-item online survey was emailed to 305 critical care practitioners in Italy. Questions included information on the participants\' background, methods of diluting norepinephrine, interpretation of recommended doses from guidelines, and a sample case related to the preparation and administration of the drug.
RESULTS: We collected 106 responses from 54 hospitals. All hospitals used norepinephrine bitartrate salt. Of the participants, 53% responded that the guidelines express norepinephrine dosages as a salt, 23% as the base form, and 24% were unsure or unaware about it. The simulated patient-dose calculation was resolved in 81% of cases with an incorrect calculation referring to the norepinephrine salt and only in 19% referring to the norepinephrine base.
CONCLUSIONS: There is significant variability in dosage management of norepinephrine across different hospital units, as well as a lack of knowledge regarding the salt-to-base ratio. Scientific publications (eg, guidelines) should specify whether they are referring to the base or salt form of norepinephrine. The adoption of different labeling and national standards for dilution may decrease the risk of therapeutic errors.
METHODS: National survey.
METHODS: Acute care units of Italian hospitals.
METHODS: Acute care physicians and nurses.
METHODS: A 15-item online survey was emailed to 305 critical care practitioners in Italy. Questions included information on the participants\' background, methods of diluting norepinephrine, interpretation of recommended doses from guidelines, and a sample case related to the preparation and administration of the drug.
RESULTS: We collected 106 responses from 54 hospitals. All hospitals used norepinephrine bitartrate salt. Of the participants, 53% responded that the guidelines express norepinephrine dosages as a salt, 23% as the base form, and 24% were unsure or unaware about it. The simulated patient-dose calculation was resolved in 81% of cases with an incorrect calculation referring to the norepinephrine salt and only in 19% referring to the norepinephrine base.
CONCLUSIONS: There is significant variability in dosage management of norepinephrine across different hospital units, as well as a lack of knowledge regarding the salt-to-base ratio. Scientific publications (eg, guidelines) should specify whether they are referring to the base or salt form of norepinephrine. The adoption of different labeling and national standards for dilution may decrease the risk of therapeutic errors.
摘要：
目的：去甲肾上腺素可以在含有其盐的溶液中购买（例如，酒石酸盐)，但只有基础形式(即，去甲肾上腺素碱）在药理学上是活跃的。不幸的是,药物包装的外标签经常报告去甲肾上腺素作为盐的剂量，当处方去甲肾上腺素时，这可能会导致治疗错误。我们进行了一项调查，以评估对这一问题的认识程度。
方法：全国调查。
方法：意大利医院的急性护理单位。
方法：急性护理医师和护士。
方法：一项15项在线调查通过电子邮件发送给意大利的305名重症监护医生。问题包括参与者的背景信息，稀释去甲肾上腺素的方法，指南中推荐剂量的解释，以及与该药物的制备和施用有关的样本案例。
结果：我们从54家医院收集了106份回复。所有医院都使用去甲肾上腺素酒石酸氢盐。在参与者中，53%的人回答说，该指南将去甲肾上腺素剂量作为盐，23%作为基础形式，24%的人对此不确定或不知情。在81％的病例中，模拟的患者剂量计算得到了解决，其中不正确的计算涉及去甲肾上腺素盐，只有19％涉及去甲肾上腺素碱。
结论：不同医院单位的去甲肾上腺素剂量管理存在显著差异，以及缺乏有关盐碱比的知识。科学出版物(如，指南）应指定它们是指去甲肾上腺素的碱形式还是盐形式。采用不同的标签和稀释国家标准可能会降低治疗错误的风险。
方法：全国调查。
方法：意大利医院的急性护理单位。
方法：急性护理医师和护士。
方法：一项15项在线调查通过电子邮件发送给意大利的305名重症监护医生。问题包括参与者的背景信息，稀释去甲肾上腺素的方法，指南中推荐剂量的解释，以及与该药物的制备和施用有关的样本案例。
结果：我们从54家医院收集了106份回复。所有医院都使用去甲肾上腺素酒石酸氢盐。在参与者中，53%的人回答说，该指南将去甲肾上腺素剂量作为盐，23%作为基础形式，24%的人对此不确定或不知情。在81％的病例中，模拟的患者剂量计算得到了解决，其中不正确的计算涉及去甲肾上腺素盐，只有19％涉及去甲肾上腺素碱。
结论：不同医院单位的去甲肾上腺素剂量管理存在显著差异，以及缺乏有关盐碱比的知识。科学出版物(如，指南）应指定它们是指去甲肾上腺素的碱形式还是盐形式。采用不同的标签和稀释国家标准可能会降低治疗错误的风险。
