ABSTRACT

Introduction:

The fact that critically ill pediatric patients have hemodynamic and metabolic characteristics different from that in adults plays a key role in the selection of vasoactive agent. The aim of this study was to compare the effects of vasoactive agent and agent groups on hemodynamics in order to effectively regulate impaired hemodynamics in critically ill pediatric patients, to provide early diagnosis, time-sensitive and targeted treatment and reduce side effects.

Methods:

Disease severity, vital signs, renal function, and laboratory data of 103 patients aged 1 to 18 years, who were treated in the pediatric intensive care unit and administered one or more vasoactive agents, were evaluated.

Results:

The average Pediatric Risk of Mortality (PRISM III-24) score in the dobutamine group was significantly higher than in the adrenalin-dobutamine group (p=0.048), and no statistically significant difference was observed between the other groups (p>0.05). There was a statistically significant difference in the mean cardıac apex beat between dopamine, dobutamine, dopamine-dobutamine and dopamine-adrenaline groups (p=0.0001, p=0.0001 p=0.007 and p=0.011, reespectively). A statistically significant difference was observed in systolic blood pressure (SAB) between dopamine-dobutamine, dopamine-adrenaline and dopamine-dobutamine-adrenaline groups (p=0.003, p=0.00 and p=0.005, respectively). The S₀ lactate levels in the adrenaline group were found to be statistically significantly higher than those in dopamine and adrenaline-dobutamine and dopamine-dobutamine-adrenaline groups (p=0.048, p=0.036 and p=0.045. There was a significant difference in S₄ lactate values between dopamine-adrenaline and adrenaline-dobutamine groups and between dobutamine and adrenaline groups (p=0.045 and p=0.047, respectively). There was no statistically significant difference in the average central venous oxygen saturation (ScVO2) between dopamine, dobutamine, dopamine-dobutamine, dopamine-adrenaline, adrenaline-dobutamine, dopamine-dobutamine-adrenaline, dopamine-dobutamine-adrenaline-noradrenaline and adrenaline groups (p>0.05). A statistically significant difference was observed between the mean amounts of urine S₀, S₂₄ and S₄₈ in the dobutamine group (p=0.002). The average S₀ urine volume in the dobutamine group was found to be statistically significantly lower than the average S₂₄, S₄₈ urine volume (p=0.01 and p=0.03, respectively). No statistically significant difference was observed between the other times and groups (p>0.05).

Conclusion:

Blood lactate levels were significantly higher in the adrenaline group than in the other groups, while no significant difference was found in cardiac apex beat, SAB, ScVO2 and amount of urine between the groups. This elevation was limited to the first 4 hours, and the use of adrenaline together with dopamine and/or dobutamine significantly reduced the incidence of hyperlactatemia compared to the use of adrenaline alone. The use of dobutamine alone significantly increased the amount of urine within hours.

Keywords: Keywords: Critically ill pediatric patient, vasoactive agent, pediatric intensive care

References

Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock 2008. Crit Care Med. 2008;36:296-327.

Han YY, Carcillo JA, Dragotta MA, Bills DM, Watson RS, et al. Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics. 2003;112:793-9.

Brierley J, Carcillo JA, Choong K, Cornell T, Decaen A, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American Collage of Critacal Care Medicine. Crit Care Med. 2009;37:666-88.

De Becker D, Creteur J, Silva E, Vincent JL. Effects of dopamine, norepinephrine and epinephrine on the splanchnic circulation in septic shock: which is the best? Crit Care Med. 2003;31:1659-67.

Van Lambalgen AA, Van Kraats AA, Mulder MF, van den Bos GC, Teerlink T, et al. Organ blood flow and distribution of cardiac output in dopexamine or dobutamine-treated endotoxemic rats. J Crit Care. 1993;8:117-27.

Gnidec AG, Finley RR, Sibbald WJ. Effect of dobutamine on lung microvascular fluid flux in sheep with ‘sepsis syndrome’. Chest. 1988;93:180-6.

Levy B, Nace L, Bollaert PE, Doussert B, Mallie JP, et al. Comparison of norepinephrine and dobutamine to epinephrine for hemodynamics, lactate metabolism and gastric tonometric variables in septic shock. Acta Pharmacol Sin. 2002;23:654-58

Vincent JL, Roman A, Kahn RJ. Dobutamine administration in septic shock: addition to a standard protocol. Crit Care Med. 1990;18:689-93.

Hannerman L, Reinhart k, Grenzer O, Meiner-Hellmann A, Bredle DL. Comparison of dopamine to do dobutamine and norepinephrine for oxygen delivery and uptake in septic shock. Crit Care Med. 1995;23:1962-70.

Martin C, Viviand X, Arnaud S, Vialet R, Rougnon T. Effects of norepinephrine plus dobutamine or norepinephrine alone on left ventricular performance of septic shock patients. Crit Care Med. 1999;27:1708-13.

Levy B, Mansart A, Bollaert PE, Franck P, Mallie JP. Effects of epinephrine and norepinephrine on hemodynamics, oxidative metabolism and organ energetics in endotoxemic rats. Intensive Care Med. 2003;29:292-300.

Kellum JA, Decker J. Use of dopamine in acute renal failure: a meta-analysis. Crit Care Med. 2001;29:1526-31.

Jakob SM, Roukonen E, Takala J. Effect of dopamine on systemic and regional blood flow and metabolism in septic and cardiac surgery patients. Shock. 2002;18:8-13.

Bollaert PE, Bauer P, Audibert G, et al. Effects of epinephrine on hemodynamics and oxygen metabolism in dopamine-resistant septic shock. Chest 1990;98:949-53.

Weycker D, Akhras KS, Edelsber J, Angus DC, Oster G. Long- term mortality and medical care charges in patients with patients with severe sepsis. Crit Care Med. 2003;31:2316-23.

Groeneveld AB, Nauta JJ, Thijs LG. Peripheral vascular resistance in septic shock: its relation to outcome. Intensive Care Med. 1988;14:141-7.

Martin C, Viviand X, Leone M, Thirion X. Effect of norepinephrine on the outcome of septic shock. Crit Care Med. 2000;28:2758-65.

Friedman G, Silva E, Vincent JL. Has the mortality of septic shock changed with time. Crit Care Med. 1998;26:2078-86.

Ventura A.M.C, Shieh H.H, Bousso A, et al. Double-Bind Prospective Randomized Controlled Trial of Dopamine Versus Epinephrine as First-Line Vasoactive Drugs in Pediatric Septic Shock. Crit Care Med. 2015;43:2292-302.

Ruokonen E, Takala J, Kari A, Saxén H, Mertsola J, et al. Regional blood flow and oxygen transport in septic shock. Crit Care Med. 1993;21:1296-303.

Trager K, Radermacher P, Rieger KM, Vlatten A, Vogt J, Iber T, et al. Norepinephrine and N-monomethyl-L-arginine in porcine septic shock. Effects on hepatic O2 exchange and energy balance. Am J Respir Crit Care Med. 1999;159:1758-65.

Murphey ED, Traber DL. Cardiopulmonary and splanchnic blood flow during 48 hours of a continuous infusion of endotoxin in conscious pigs: a model of hyperdynamic shock. Shock. 2000;13:224-9.

Martin C, Papazian L, Perin G, Saux P, Gouin F. Norepinephrine or dopamine for treatment of hyperdynamic septic shock. Chest. 1993;103:1826-31.

Desjars P, Pinaud M, Brignon D, Tasseau F. Norepinephrine therapy has no deleterios renal effects in human septic shock. Crit Care Med. 1989;17:426-9.

Meadows D, Edwards JD, Wilkins RG, Nightingale P. Reversal of intractable septic shock with norepinephrine therapy. Crit Care Med. 1988;16:663-6.

Davis AL, Carcillo JA, Aneja RK, Deymann AJ, Lin JC, et al. American Collage of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Crit Care Med. 2017;45:1061-1093.

Effects of Vasoactive Drug Use on Hemodynamics in Critical Disease Pediatic Patients

ABSTRACT

References