Pediatric Critical Care Medicine:
Abstracts of the 7th World Congress on Pediatric Critical Care
ABSTRACT 6: RANDOMIZED DOUBLE-BLIND TRIAL OF DOPAMINE OR EPINEPHRINE AS FIRST-LINE VASOACTIVE DRUGS IN FLUID REFRACTORY PEDIATRIC SEPTIC SHOCK
Ventura, A.1; Góes, P.1; Fernandes, I.C.1; Hsin, S.H.1; Souza, D.C.1; Gaiga, L.1; Bousso, A.1; Gilio, A.E.1
1Department of Pediatrics - Intensive Care Unit, University of São Paulo, São Paulo, Brazil
Background and aims: Guidelines for severe sepsis and septic shock treatment in children suggest that dopamine or epinephrine can be used as first line drugs. This recommendation is, however, still a matter of debate.
Aims: Our goal was to compare the effects of dopamine or epinephrine regarding the need for other vasoactive drugs, nosocomial infection rates and 28-day mortality.
Methods: IRB approved the study, written informed consent was obtained. Between 02/09-07/13 all children with fluid refractory septic shock were considered eligible. After applying exclusion criteria, patients were randomly assigned to receive either dopamine (drug A=5-7.5-10mcg/Kg/min) or epinephrine (drug B=0.1-0.2-0.3mcg/Kg/min). Hemodynamic variables were recorded. Treatment failure was considered if predefined stabilization criteria were not achieved after maximum dose. Nosocomial infection was defined according to CDC recommendations. All baseline characteristics and results were submitted to complete statistical analysis considering p values <0.05 to be statistically significant.
Results: One-hundred-twenty children (58% male) were enrolled (63 for dopamine and 57 for epinephrine). Baseline characteristics were similar between groups. Mean age (±SD) 39.6 ± 46.3 for dopamine and 56.9 ± 58.2 months for epinephrine (p=0.14). There were 17 deaths (14.2%), 13 (20.6%) in the dopamine group and 4 (7%) in the epinephrine group (p=0.033). The use of dopamine was statistically associated with death (OR=6.5; 95%CI:1.1–37.8,p=0.037) and nosocomial infection (OR=67.7; 95% CI: 5.0–910.8; p=0.001). Death occurred in a significantly shorter period of time for those who received dopamine(p = 0,047).
Conclusions: The use of dopamine as first line vasoactive drug for pediatric septic shock may be associated with higher nosocomial infection and mortality rates.
©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies