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Pediatric Cardiac Intensive Care Society 2014 Consensus Statement

Pharmacotherapies in Cardiac Critical Care Antihypertensives

Klugman, Darren MD, MS; Goswami, Elizabeth S. PharmD; Berger, John T. MD

doi: 10.1097/PCC.0000000000000621
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Objective: Hypertension remains a common condition in pediatric cardiac intensive care. The physiologic effects of hypertension in this population are complex and are impacted by patient age, comorbidities, and primary cardiac disease. The objective of this study is to review current pharmacotherapies for the management of systemic hypertension in the pediatric cardiac ICU.

Data Sources: Relevant literature to the treatment of systemic hypertension in children was included. Specific focus was given to literature studying the use of therapies in critically ill children and those with heart disease. Reference textbooks and drug packaging inserts were used for drug-specific pediatric guidelines.

Study Selection: A search of MEDLINE, PubMed, and the Cochrane Database was performed to find literature about the management of hypertension in children. Metaanalyses and pediatric-specific studies were primarily considered and cross-referenced. Pertinent adult studies were included.

Data Extraction: Once the studies for inclusion were finalized, priority for data extraction was given to pediatric-specific studies that focused on children with heart disease and critical illness.

Conclusions: Systemic hypertension is common, and there is significant heterogeneity in the patient population with critical heart disease. There are limited large, prospective analyses of safety and efficacy for pediatric drug antihypertensive agents. Despite patient heterogeneity, most pharmacotherapies are safe and efficacious.

1Department of Critical Care Medicine and Cardiology, Children’s National Medical Center, Washington, DC.

2Department of Pharmacy, Riley Hospital for Children, Indianapolis, IN.

3Department of Pediatrics, Children’s National Medical Center, Washington, DC.

Dr. Goswami disclosed that the article discusses off-label use of approved medications, as many medications do not have specific pediatric labeling. She received funding from the American College of Clinical Pharmacy. Dr. Berger’s institution received funding from the National Institutes of Health and the Association for Pediatric Pulmonary Hypertension. Dr. Klugman has disclosed that he does not have any potential conflicts of interest.

For information regarding this article, E-mail: Darren.Klugman@childrensnational.org

©2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies