Aims & Objectives:
To compare the haemodynamic response of Vasopressin with Noradrenaline in Dopamine resistant, fluid refractory warm shock among children in Paediatric Intensive Unit and to assess overall outcome.
We randomized patients into Vasopressin and Noradrenaline groups. Low doses were started (Vasopressin = 0.02 IU/kg/hr versus Noradrenaline 0.02 mcg/kg/min) and dose titration was done to achieve the therapeutic end points at 6 hours. Data was analyzed using student’s t-test, chi-square test, Mann-Whitney test and Regression analysis. Kaplan-Meier Survival curves were used to analyze the mortality outcome.
Forty patients were randomized into Vasopressin and Noradrenaline groups (20 in each group). The baseline characteristics between the groups were comparable with no statistical difference. Improvement in the heart rate, lactate and base excess were better seen in the Vasopressin group, though not statistically significant (p = 0.65, p = 0.26 and p = 0.64 respectively). In the 40 participants, 37(92.5%) achieved the therapeutic end points of SBP at end of 6 hours, among which 18 (90%) were in Vasopressin group and 19 (95%) were in Noradrenaline group. However there was no statistical significance in the 28-day mortality rate among the two groups (Vasopressin = 48% and Noradrenaline = 42%, p = 0.77)
•Vasopressin is comparable and non-inferior to Noradrenaline on the hemodynamic status in Fluid Refractory Dopamine Resistant warm septic shock without any significant difference in the critical adverse events
Larger trials are required to authenticate the effectiveness of Vasopressin in Pediatric Septic shock.