Noradrenaline use for septic shock in children: doses, routes of administration and complications

Acta Pediatrica, 05/09/2012

Lampin ME et al. – Higher doses of noradrenaline than those suggested in the literature may be necessary to reverse hypotension and hypoperfusion. The use of noradrenaline through peripheral venous access or intra–osseous route was safe, without any adverse effects.

Methods

  • Retrospective single-center review of children with septic shock who received NA between 2000 and 2010.
  • The authors identified 144 children with septic shock treated with noradrenaline, in 22% as the first-line drug.

Results

  • The median volume resuscitation before vasoactive agent administration was 50ml/kg [IQR: 30-70].
  • Mean doses of noradrenaline ranged from 0.5±0.4µg/kg/min (starting dose) to 2.5±2.2µg/kg/min (maximum dose).
  • Noradrenaline was administered via peripheral venous access or intra-osseous route in 19% of cases for a median duration of 3hours [IQR: 2-4] without any adverse effects.
  • The use of noradrenaline increased over the study period.
  • Mortality rate was 45% with a significant decrease over the study period.
  • Adverse effects included arrhythmia in 2 children and hypertension in 8 children.
  • None of these arrhythmias required treatment and hypertension resolved with the noradrenaline dose reduction.

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