PDF herunterladen
J Pediatr Intensive Care 2020; 09(03): 172-180
DOI: 10.1055/s-0040-1705181
Original Article
Georg Thieme Verlag KG Stuttgart · New York

High-Dose Vasopressor Therapy for Pediatric Septic Shock: When Is Too Much?

Paulo Sérgio Lucas da Silva
1   Pediatric Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal, São Paulo, Brazil
,
Marcelo Cunio Machado Fonseca
2   Health Technologies Assessment Center, Federal University of São Paulo, São Paulo, Brazil
› Institutsangaben
Weitere Informationen

Publikationsverlauf

10. November 2019

27. Januar 2020

Publikationsdatum:
09. März 2020 (online)

    Lizenzen und Reprints

Abstract

It is unknown if the requirement for high dose of vasopressor (HDV) represents a poor outcome in pediatric septic shock. This is a retrospective observational analysis with data obtained from a single center. We evaluated the association between the use of HDV and survival in these patients. A total of 62 children (38 survivors and 24 nonsurvivors) were assessed. The dose of vasopressor (hazard ratio 2.06) and oliguria (hazard ratio 3.17) was independently associated with mortality. The peak of vasopressor was the best prognostic predictor. A cutoff of 1.3 μg/kg/min was associated with mortality with a sensitivity of 75% and specificity of 89%. Vasopressor administration higher than 1.3 μg/kg/min was associated with increased mortality in children with septic shock.

Keywords

mortality - septic shock - vasopressor
 

  • References

  • 1 Davis AL, Carcillo JA, Aneja RK. , et al. American College of Critical Care medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med 2017; 45 (06) 1061-1093
    CrossrefPubMedGoogle Scholar
  • 2 Jentzer JC, Vallabhajosyula S, Khanna AK, Chawla LS, Busse LW, Kashani KB. Management of refractory vasodilatory shock. Chest 2018; 154 (02) 416-426
    CrossrefPubMedGoogle Scholar
  • 3 Jentzer JC, Coons JC, Link CB, Schmidhofer M. Pharmacotherapy update on the use of vasopressors and inotropes in the intensive care unit. J Cardiovasc Pharmacol Ther 2015; 20 (03) 249-260
    CrossrefPubMedGoogle Scholar
  • 4 Döpp-Zemel D, Groeneveld AB. High-dose norepinephrine treatment: determinants of mortality and futility in critically ill patients. Am J Crit Care 2013; 22 (01) 22-32
    CrossrefPubMedGoogle Scholar
  • 5 Brown SM, Lanspa MJ, Jones JP. , et al. Survival after shock requiring high-dose vasopressor therapy. Chest 2013; 143 (03) 664-671
    CrossrefPubMedGoogle Scholar
  • 6 Bassi E, Park M, Azevedo LC. Therapeutic strategies for high-dose vasopressor-dependent shock. Crit Care Res Pract 2013; 2013: 654708
    PubMedGoogle Scholar
  • 7 Martin C, Medam S, Antonini F. , et al. Norepinephrine: not too much, too long. Shock 2015; 44 (04) 305-309
    CrossrefPubMedGoogle Scholar
  • 8 Benbenishty J, Weissman C, Sprung CL, Brodsky-Israeli M, Weiss Y. Characteristics of patients receiving vasopressors. Heart Lung 2011; 40 (03) 247-252
    CrossrefPubMedGoogle Scholar
  • 9 Jenkins CR, Gomersall CD, Leung P, Joynt GM. Outcome of patients receiving high dose vasopressor therapy: a retrospective cohort study. Anaesth Intensive Care 2009; 37 (02) 286-289
    CrossrefPubMedGoogle Scholar
  • 10 Sviri S, Hashoul J, Stav I, van Heerden PV. Does high-dose vasopressor therapy in medical intensive care patients indicate what we already suspect?. J Crit Care 2014; 29 (01) 157-160
    CrossrefPubMedGoogle Scholar
  • 11 Lampin ME, Rousseaux J, Botte A, Sadik A, Cremer R, Leclerc F. Noradrenaline use for septic shock in children: doses, routes of administration and complications. Acta Paediatr 2012; 101 (09) e426-e430
    CrossrefPubMedGoogle Scholar
  • 12 Menif K, Khaldi A, Bouziri A. , et al. Mortality rates in pediatric septic shock secondary to community-acquired infection: about 70 cases [in French]. Med Mal Infect 2009; 39 (12) 896-900
    CrossrefPubMedGoogle Scholar
  • 13 Ramaswamy KN, Singhi S, Jayashree M, Bansal A, Nallasamy K. Double-blind randomized clinical trial comparing dopamine and epinephrine in pediatric fluid-refractory hypotensive septic shock. Pediatr Crit Care Med 2016; 17 (11) e502-e512
    CrossrefPubMedGoogle Scholar
  • 14 Sprung CL, Cohen SL, Sjokvist P. , et al; Ethicus Study Group. End-of-life practices in European intensive care units: the Ethicus study. JAMA 2003; 290 (06) 790-797
    CrossrefPubMedGoogle Scholar
  • 15 de Caen AR, Berg MD, Chameides L. , et al. Part 12: pediatric advanced life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care (Reprint). Pediatrics 2015; 136 (Suppl. 02) S176-S195
    CrossrefPubMedGoogle Scholar
  • 16 Auchet T, Regnier MA, Girerd N, Levy B. Outcome of patients with septic shock and high-dose vasopressor therapy. Ann Intensive Care 2017; 7 (01) 43
    CrossrefPubMedGoogle Scholar
  • 17 Pollack MM, Ruttimann UE, Getson PR. Pediatric risk of mortality (PRISM) score. Crit Care Med 1988; 16 (11) 1110-1116
    CrossrefPubMedGoogle Scholar
  • 18 Leteurtre S, Martinot A, Duhamel A. , et al. Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet 2003; 362 (9379): 192-197
    CrossrefPubMedGoogle Scholar
  • 19 Brierley J, Carcillo JA, Choong K. , et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med 2009; 37 (02) 666-688
    CrossrefPubMedGoogle Scholar
  • 20 Feudtner C, Hays RM, Haynes G, Geyer JR, Neff JM, Koepsell TD. Deaths attributed to pediatric complex chronic conditions: national trends and implications for supportive care services. Pediatrics 2001; 107 (06) E99
    CrossrefPubMedGoogle Scholar
  • 21 Choi BC. Slopes of a receiver operating characteristic curve and likelihood ratios for a diagnostic test. Am J Epidemiol 1998; 148 (11) 1127-1132
    CrossrefPubMedGoogle Scholar
  • 22 Kim YA, Ha EJ, Jhang WK, Park SJ. Early blood lactate area as a prognostic marker in pediatric septic shock. Intensive Care Med 2013; 39 (10) 1818-1823
    CrossrefPubMedGoogle Scholar
  • 23 Jat KR, Jhamb U, Gupta VK. Serum lactate levels as the predictor of outcome in pediatric septic shock. Indian J Crit Care Med 2011; 15 (02) 102-107
    CrossrefPubMedGoogle Scholar
  • 24 Fuhrman BP, Zimmerman JJ. Pediatric critical care. In: Bass JL, Shepard CW. Echocardiographic Imaging: Noninvasive Cardiac Diagnosis. 5th ed. Philadelphia, PA: Elsevier; 2017: 325-340
    Google Scholar
  • 25 Sankar J, Das RR, Jain A. , et al. Prevalence and outcome of diastolic dysfunction in children with fluid refractory septic shock—a prospective observational study. Pediatr Crit Care Med 2014; 15 (09) e370-e378
    CrossrefPubMedGoogle Scholar
  • 26 Xing XZ, Wang HJ, Huang CL. , et al. Prognosis of patients with shock receiving vasopressors. World J Emerg Med 2013; 4 (01) 59-62
    CrossrefPubMedGoogle Scholar
  • 27 Brand DA, Patrick PA, Berger JT. , et al. Intensity of vasopressor therapy for septic shock and the risk of in-hospital death. J Pain Symptom Manage 2017; 53 (05) 938-943
    CrossrefPubMedGoogle Scholar
  • 28 Dünser MW, Ruokonen E, Pettilä V. , et al. Association of arterial blood pressure and vasopressor load with septic shock mortality: a post hoc analysis of a multicenter trial. Crit Care 2009; 13 (06) R181
    CrossrefPubMedGoogle Scholar
  • 29 Andreis DT, Singer M. Catecholamines for inflammatory shock: a Jekyll-and-Hyde conundrum. Intensive Care Med 2016; 42 (09) 1387-1397
    CrossrefPubMedGoogle Scholar