Comparison of vasoactive medications and investigation determinants of mortality in children

Introduction

The study objective was to review the current use of vasoactive medications in our ICU and to compare vasoactive medications with respect to therapeutic end points and the choice of agent. The second objective was to determine prognostic factors that effect survival in critically ill pediatric patients.

Methods

The data of patients admitted to the Istanbul Faculty of Medicine Pediatric ICU between January 2004 and January 2005 were investigated retrospectively.

Results

During the study period, vasoactive medications (dobutamine and/or dopamine, epinephrine) were used in 63 patients. The median age of the patients was 96.5 months (1–192) and 52.4% (n = 33) of the patients were male. Of the patients, 28.6% (n = 18) died. The patients in the epinephrine treatment group were sicker than those in the dobutamine and/or dopamine groups. The pH and base deficit levels improved earlier in the epinephrine therapy than in the dobutamine and/or dopamine therapies. In the patients treated with epinephrine, the lactate concentration initially increased, but decreased to the basal level in the 8-hour observation period. The heart rate was higher at admission and during the follow-up in nonsurvivors than survivors but was not statistically significant. The relationship between increasing lactate concentration and mortality was statistically significant (P < 0.01).

Conclusion

Early initiation of epinephrine may offer survival benefit to critically ill pediatric shock patients. The lactate concentration may increase transiently in patients treated with epinephrine. The decrease in the heart rate and lactate concentration are important determinants of outcome.