Clinical outcome of children with fluid-refractory septic shock treated with dopamine or epinephrine. A retrospective study at a pediatric emergency department in Argentina

Kohn-Loncarica, Guillermo; Fustiñana, Ana; Santos, César; Lantelli, Guadalupe Paniagua; Rowensztein, Hernán; González‐Dambrauskas, Sebastián

doi:10.5935/0103-507x.20200092

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…[18][19][20] Our study showed good adherence to this recommendation as most children were treated with epinephrine instead of dopamine. Dopamine has historically been the drug of choice for the treatment of fluid-refractory PSS 20,61,62 ; however, recent studies have shown superiority of epinephrine over dopamine. [63][64][65][66] The replacement of dopamine by epinephrine may be an easier intervention compared with other more time-sensitive goals.…”

Section: Discussionmentioning

confidence: 99%

Adherence to Pediatric Sepsis Treatment Recommendations at Emergency Departments

Fustiñana¹,

Yock‐Corrales²,

Casson³

et al. 2022

Pediatr Emer Care

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Objective: Sepsis is one of the most urgent health care issues worldwide.Guidelines for early identification and treatment are essential to decrease sepsis-related mortality. Our aim was to collect data on the epidemiology of pediatric septic shock (PSS) from the emergency department (PED) and to assess adherence to recommendations for its management in the first hour.Methods: A multicenter, prospective, cross-sectional study was conducted evaluating children with PSS seen at the PED of 10 tertiary-care centers in Latin America. Adherence to guidelines was evaluated. Results:We included 219 patients (median age, 3.7 years); 43% had comorbidities, 31% risk factors for developing sepsis, 74% clinical signs of "cold shock," and 13% of "warm shock," 22% had hypotension on admission. Consciousness was impaired in 55%. A peripheral line was used as initial access in 78% (median placement time, 10 minutes). Fluid and antibiotics infusion was achieved within a median time of 30 minutes (interquartile range [IQR], 20-60 minutes) and 40 minutes (IQR, 20-60 minutes), respectively; 40% responded inadequately to fluids requiring vasoactive drugs (median time at initiation, 60 minutes; IQR, 30-135 minutes). Delay to vasoactive drug infusion was significantly longer when a central line was placed compared to a peripheral line (median time, 133 minutes [59-278 minutes] vs 42 minutes [30-70 minutes], respectively [P < 0.001]). Adherence to all treatment goals was achieved in 13%. Mortality was 10%. An association between mortality and hypotension on admission was found (26.1% with hypotension vs 4.9% without; P < 0.001).

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Section: Discussionmentioning

confidence: 99%

Adherence to Pediatric Sepsis Treatment Recommendations at Emergency Departments

Fustiñana¹,

Yock‐Corrales²,

Casson³

et al. 2022

Pediatr Emer Care

Self Cite

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“…There may also be age-related differences in how immune cells and the cardiovascular system respond to dopamine, which need to be further explored. In addition, a number of studies show that dopamine treatment is as safe and effective as other treatments, and randomized trials in neonates and pediatric patients who were septic and treated with dopamine or epinephrine showed no difference in long-term mortality and comparable efficacy and safety ( Baske et al, 2018 ; Kohn-Loncarica et al, 2020 ). In patients treated with norepinephrine, dopamine, or a combination of norepinephrine and vasopressin, the recommended vasoactive therapy for sepsis, dopamine shortened intensive care unit and hospital stays compared with the other therapies ( Zhou, Zhu et al, 2021 ).…”

Section: Regional and Disease-specific Effects Of Dopaminementioning

confidence: 99%

Dopamine, Immunity, and Disease

et al. 2022

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The neurotransmitter dopamine is a key factor in central nervous system (CNS) function, regulating many processes including reward, movement, and cognition. Dopamine also regulates critical functions in peripheral organs, such as blood pressure, renal activity, and intestinal motility. Beyond these functions, a growing body of evidence indicates that dopamine is an important immunoregulatory factor. Most types of immune cells express dopamine receptors and other dopaminergic proteins, and many immune cells take up, produce, store, and/or release dopamine, suggesting that dopaminergic immunomodulation is important for immune function. Targeting these pathways could be a promising avenue for the treatment of inflammation and disease, but despite increasing research in this area, data on the specific effects of dopamine on many immune cells and disease processes remain inconsistent and poorly understood. Therefore, this review integrates the current knowledge of the role of dopamine in immune cell function and inflammatory signaling across systems. We also discuss the current understanding of dopaminergic regulation of immune signaling in the CNS and peripheral tissues, highlighting the role of dopaminergic immunomodulation in diseases such as Parkinson’s disease, several neuropsychiatric conditions, neurologic human immunodeficiency virus, inflammatory bowel disease, rheumatoid arthritis, and others. Careful consideration is given to the influence of experimental design on results, and we note a number of areas in need of further research. Overall, this review integrates our knowledge of dopaminergic immunology at the cellular, tissue, and disease level and prompts the development of therapeutics and strategies targeted toward ameliorating disease through dopaminergic regulation of immunity. Significance Statement Canonically, dopamine is recognized as a neurotransmitter involved in the regulation of movement, cognition, and reward. However, dopamine also acts as an immune modulator in the central nervous system and periphery. This review comprehensively assesses the current knowledge of dopaminergic immunomodulation and the role of dopamine in disease pathogenesis at the cellular and tissue level. This will provide broad access to this information across fields, identify areas in need of further investigation, and drive the development of dopaminergic therapeutic strategies.

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Comprehensive Management of Blood Pressure in Patients with Septic AKI

Deng

Feng

et al. 2023

JCM

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Acute kidney injury (AKI) is one of the serious complications of sepsis in clinical practice, and is an important cause of prolonged hospitalization, death, increased medical costs, and a huge medical burden to society. The pathogenesis of AKI associated with sepsis is relatively complex and includes hemodynamic abnormalities due to inflammatory response, oxidative stress, and shock, which subsequently cause a decrease in renal perfusion pressure and eventually lead to ischemia and hypoxia in renal tissue. Active clinical correction of hypotension can effectively improve renal microcirculatory disorders and promote the recovery of renal function. Furthermore, it has been found that in patients with a previous history of hypertension, small changes in blood pressure may be even more deleterious for kidney function. Therefore, the management of blood pressure in patients with sepsis-related AKI will directly affect the short-term and long-term renal function prognosis. This review summarizes the pathophysiological mechanisms of microcirculatory disorders affecting renal function, fluid management, vasopressor, the clinical blood pressure target, and kidney replacement therapy to provide a reference for the clinical management of sepsis-related AKI, thereby promoting the recovery of renal function for the purpose of improving patient prognosis.

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Clinical outcome of children with fluid-refractory septic shock treated with dopamine or epinephrine. A retrospective study at a pediatric emergency department in Argentina

Cited by 3 publications

References 19 publications

Adherence to Pediatric Sepsis Treatment Recommendations at Emergency Departments

Adherence to Pediatric Sepsis Treatment Recommendations at Emergency Departments

Dopamine, Immunity, and Disease

Comprehensive Management of Blood Pressure in Patients with Septic AKI

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