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

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.

Safety and feasibility of immediate tracheal extubation of small pediatric patients after living donor liver transplantation

“…Vasopressor drugs have a log‐linear dose response curve, with decreasing incremental effectiveness at higher doses and likely a greater potential for toxicity 13 . A cutoff of 1.3 μg/kg/min of vasopressor infusion was found to be associated with mortality with a sensitivity of 75% and specificity of 89% in pediatric patients with septic shock 7 . So may be our cutoff for high‐dose vasopressor therapy was low and further research are warranted to define cutoff for high‐dose vasopressor therapy for non extubation in OR.…”

“…Sahinturk 1 et al found high‐dose vasopressor as risk factor for not extubation in OR but they did not describe what is high‐dose vasopressor therapy in pediatric patients. We defined high‐dose vasopressor therapy as either 2 vasoactive medicines required to maintain blood pressure or noradrenaline dose more than 0.3 μg/kg/min 7 . Fullington 11 et.al also did not extubated the patient who were on >1 vasopressor during time period (2005–2008); however, they started extubating patients with more than 1 vasopressor during time period (2008–2011).…”

“…Age, gender, weight, preoperative diagnosis, preoperative location (ward/ICU), MELD/PELD, blood product transfusion (ml/kg), high vasopressor support (defined by more than one inotrope and/or Noradrenaline dose more than 0.3 microgram/kg/min 7 …”

“…Age, gender, weight, preoperative diagnosis, preoperative location (ward/ICU), MELD/PELD, blood product transfusion (ml/kg), high vasopressor support (defined by more than one inotrope and/or Noradrenaline dose more than 0.3 microgram/kg/min. 7 ), warm ischemia time (WIT), cold ischemia time (CIT), graft recipient weight ratio (GRWR), reintubation within 24 h, outcome variables assessed were hospital stay, postoperative interventions, sepsis (culture positive), hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT), re-exploration, and 30 days and 180 days mortality.…”

Relationship between Dynamic Changes of Microcirculation Flow, Tissue Perfusion Parameters, and Lactate Level and Mortality of Septic Shock in ICU

“…The patient's condition progresses rapidly and poses a serious threat to the safety of patients. The basic pathological features of the patients were systemic vascular dilatation and increased capillary permeability, showing insufficient circulating blood volume, reduced tissue perfusion, and systemic metabolic disorder [ 1 ]. Accurate evaluation of tissue perfusion for patients with septic shock is of great significance for guiding clinical treatment, and the prognosis of patients' needs to be evaluated.…”