Double-Blind Prospective Randomized Controlled Trial of Dopamine Versus Epinephrine as First-Line Vasoactive Drugs in Pediatric Septic Shock

Ventura, Andrea; Shieh, Huei Hsin; Bousso, Albert; Góes, Patrícia Freitas; Fernandes, Iracema de Cássia F. O.; Souza, Daniela Carla de; Paulo, Rodrigo Locatelli Pedro; Chagas, Fabiana; Gilio, Alfredo Elias

doi:10.1097/01.sa.0000490923.11164.35

Cited by 7 publications

(9 citation statements)

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“…However, as it did not make a clear recommendation for or against the use of dopamine, dopamine may still be used frequently in clinical practice in Japan [ 877 ]. A systematic review yielded 2 RCTs that conformed to the PICO criteria [ 823 , 878 ], and we conducted a meta-analysis of these trials. Both RCTs set adrenaline as a comparative control.…”

Section: Methods Used For Creating This Guidelinementioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020)

et al. 2021

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members.As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

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Section: Methods Used For Creating This Guidelinementioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020)

et al. 2021

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“…The results indicated norepinephrine to be a more prudent choice [19]. Initial studies indicated that dopamine increases contractility of myocardial tissues allowing the effect of pharmacological titration, and hence, it has been considered and recommended as the first choice for treating shock [27,28].…”

Section: Discussionmentioning

confidence: 99%

Comparing the Use of Dopamine and Norepinephrine in Shock Treatment

Jalalyazdi¹,

Parvizian²,

Abyaneh³

2016

Cardiovasc Pharm Open Access

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IntroductionCardiovascular shock refers to a critical condition that occurs when a patient's heart suddenly fails to pump blood as required by the body. This rare but fatal condition is mostly caused by heart attack and is linked to high death rate [1,2]. The fluid administration that forms the firstline of therapeutic strategy does not offer enough stability for the condition of the patient, and the adrenergic agents are regularly needed to correct hypertension [3]. Among the most frequently used agents are dopamine and norepinephrine. Both dopamine and norepinephrine affect the alpha-adrenergic and beta-adrenergic receptors, though to varying degrees. The effects of alpha-adrenergic receptors lead to increased vascular tone. However, it could decrease the cardiac output as well as the regional flow of blood, particularly in cutaneous, renal, and splanchnic beds [4].On the other hand, beta-adrenergic effects assist in the maintenance of blood flow through inotropic and chronotropic effects as well as increasing splanchnic perfusion. This stimulation from the betaadrenergic effects can bring out the unwanted consequences, including an increase in the cellular metabolism and immunosuppressive effects [5]. Besides, dopamine arouses dopaminergic receptors, which leads to a uniformly bigger rise in renal and splanchnic perfusion, which can expedite lung edema tenacity. Conversely, the stimulation caused by dopamine could lead to negative immunological effects by modifying hypothalamic-pituitary function, leading to a patent drop of prolactin as well as the level of hormones [6].Hypothetically, norepinephrine and dopamine have varying effects in the splanchnic, kidney and pituitary axis, though the medical consequences of the implied differences are not certain [7]. Experts have recommended that any of the two compounds may be chosen first and applied as a vasopressor in patients suffering from shock. Studies have Comparing the Use of Dopamine and Norepinephrine in Shock Treatment AbstractBackground: The vasopressor agents, such as norepinephrine and dopamine have been endorsed as the standard choice for shock treatment. However, there is controversy regarding the use of vasopressor agents for shock treatment. Considering the use of norepinephrine over dopamine, the present study aimed at assessing the reasons for the reduced death rate among the patients who were in shock.

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“…Vasopressor selection is often debated, but inotropic support with epinephrine is a reasonable first choice. 9 Pediatric POCUS is an emerging modality that physicians are becoming more comfortable with implementing in their practice. Visualization with ultrasound is a fast and easy tool that can be used upon arrival before any laboratory tests have been released.…”

Section: Pocus In Early Diagnosis Of Cardiomyopathy In a Childmentioning

confidence: 99%

Point-of-care Ultrasound in Early Diagnosis of Cardiomyopathy in a Child with Viral Myocarditis: A Case Report

Gupta

Eckenswiller

2021

Clinical Practice and Cases in Emergency Medicine

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Introduction: Pediatric myocarditis is a commonly missed diagnosis in the pediatric emergency department (ED) with high morbidity and mortality. The presentation of cardiogenic shock secondary to myocarditis and septic shock can be difficult to differentiate during initial resuscitation, and incorrect treatment can lead to poor prognosis. Early diagnosis may provide a better prognosis for this life-threatening condition. Case Report: We report a case of a five-year-old female who presented to the ED with non-specific symptoms of myocarditis. Rapid point-of-care ultrasound led to early diagnosis, correct management, and great prognosis for the patient. Conclusion: Providers must maintain a high index of suspicion for cardiogenic shock in patients with nonspecific symptoms and fluid unresponsiveness. Point-of-care ultrasound can help in the identification of cardiac disorders and guide practitioners in their management plans.

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Double-Blind Prospective Randomized Controlled Trial of Dopamine Versus Epinephrine as First-Line Vasoactive Drugs in Pediatric Septic Shock

Cited by 7 publications

References 1 publication

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020)

Comparing the Use of Dopamine and Norepinephrine in Shock Treatment

Point-of-care Ultrasound in Early Diagnosis of Cardiomyopathy in a Child with Viral Myocarditis: A Case Report

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