Clinical outcome of children with fluid-refractory septic shock treated with dopamine or epinephrine. A retrospective study at a pediatric emergency department in Argentina

Kohn-Loncarica, Guillermo; Fustiñana, Ana; Santos, César; Lantelli, Guadalupe Paniagua; Rowensztein, Hernan; González-Dambrauskas, Sebastián

doi:10.5935/0103-507X.20200092

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Revista Brasileira de Terapia Intensiva

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ORIGINAL ARTICLE • Rev. bras. ter. intensiva 32 (4) • Oct-Dec 2020 • https://doi.org/10.5935/0103-507X.20200092 copy

Clinical outcome of children with fluid-refractory septic shock treated with dopamine or epinephrine. A retrospective study at a pediatric emergency department in Argentina

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze the clinical outcome of children with fluid-refractory septic shock initially treated with dopamine or epinephrine.

Methods:

A retrospective cohort study was conducted at a pediatric emergency department of a tertiary hospital. Population: children admitted because of fluid-refractory septic shock. Clinical outcome was compared between two groups: Dopamine and Epinephrine. Variables evaluated were use of invasive mechanical ventilation, days of inotropic therapy, length of hospital stay, intensive care stay, and mortality. For numerical and categorical variables, we used measures of central tendency. They were compared by the Mann-Whitney U-test and the (2 test.

Results:

We included 118 patients. A total of 58.5% received dopamine and 41.5% received epinephrine. The rate of invasive mechanical ventilation was 38.8% for epinephrine versus 40.6% for dopamine (p = 0.84), with a median of 4 days for the Epinephrine Group and 5.5 for the Dopamine Group (p = 0.104). Median time of inotropic therapy was 2 days for both groups (p = 0.714). Median hospital stay was 11 and 13 days for the Epinephrine and Dopamine groups, respectively (p = 0.554), and median stay in intensive care was 4 days (0 - 81 days) in both groups (p = 0.748). Mortality was 5% for the Epinephrine Group versus 9% for the Dopamine Group (p = 0.64).

Conclusions:

At our center, no differences in use of invasive mechanical ventilation, time of inotropic therapy, length of hospital stay, length of intensive care unit stay, or mortality were observed in children admitted to the pediatric emergency department with a diagnosis of fluid-refractory septic shock initially treated with dopamine versus epinephrine.

Keywords:
Sepsis; Shock, septic; Dopamine; Epinephrine; Cardiovascular agents; Child

Population variables	Epinephrine Group n = 49	Dopamine Group n = 69	p value^* * χ2 test; † Mann-Whitney U-test. Results expressed as n (%) or median (interquartile range). †
Male	31(63)	39 (57)	0.46^* * χ2 test; † Mann-Whitney U-test. Results expressed as n (%) or median (interquartile range).
Age (months)	63 (19 - 92)	81 (31 - 144)	0.09†
Chronic condition
Yes	27 (55)	52 (75)	0.032^* * χ2 test; † Mann-Whitney U-test. Results expressed as n (%) or median (interquartile range).
Oncological	7 (14)	30 (43)	0.007^* * χ2 test; † Mann-Whitney U-test. Results expressed as n (%) or median (interquartile range).
With immunodeficiency (n = 117)	13 (27)	37 (54)	0.003^* * χ2 test; † Mann-Whitney U-test. Results expressed as n (%) or median (interquartile range).
With source of infection	39 (80)	54 (78)	0.8^* * χ2 test; † Mann-Whitney U-test. Results expressed as n (%) or median (interquartile range).
Source
Digestive	18 (37)	16 (23)
Respiratory	6 (12)	21 (30)
Skin and soft parts	11 (22)	10 (15)
Urinary	2 (4)	2 (3)
Associated with catheter	1 (2)	4 (6)
Central nervous system	1 (2)	1 (1)
Arterial hypotension at baseline	20 (45)	21 (30)	0.2^* * χ2 test; † Mann-Whitney U-test. Results expressed as n (%) or median (interquartile range).
Positive blood cultures	11 (22)	27 (39)	0.04^* * χ2 test; † Mann-Whitney U-test. Results expressed as n (%) or median (interquartile range).
Germ in blood culture
Gram-negative bacillus	6 (55)	12 (44)
Methicillin-resistant Staphylococcus aureus	2 (18)	6 (22)
Methicillin-sensitive Staphylococcus aureus	1 (9)	2 (7)
Other	2 (18)	7 (27)

Treatment interventions	Epinephrine Group n = 49	Dopamine Group n = 69	p value^* * χ2 test. Results expressed as n (%) or n.
Antibiotics in the first 60 minutes (n = 117)	36 (73)	68 (99)	< 0.001^* * χ2 test. Results expressed as n (%) or n.
Reason for indication of the inotropic drug (n = 113)	47	66
Fluid-refractory (60mL/kg)	38 (81)	34 (52)
Signs of fluids overload	0	6 (9)
Poor general condition	9 (19)	26 (39)
Intubation in the emergency room (n = 116)	10 (20)	7 (10)	0.1^* * χ2 test. Results expressed as n (%) or n.

	Epinephrine Group n = 49	Dopamine Group n = 69	p value^* * χ2 test; † Mann-Whitney U-test. Results expressed as n (%) or median in days. †	OR (95%CI)
Death	5 (10)	9 (13)		1.32 (0.41 - 4.21)
IMV	19 (39)	28 (41)		1.07 (0.50 - 2.28)
IMV days	4	5,5	0.104†
Days of hospitalization	11	13	0.554†
Days of inotropic drugs	2	2	0.714†
Days at ICU	4	4	0.748†

	Epinephrine Group n = 42	Dopamine Group n = 39	p value^* * χ2 test; † Mann-Whitney U-test. Results expressed as n (%) or median in days. †	OR (95%CI)
Death	5 (12)	4 (10)		1.18 (0.29 - 4.76)
IMV	18 (43)	17 (44)		0.97 (0.40 - 2.33)
IMV days	3.5 (1 - 7)	6 (4.5 - 10.5)	0.062†
Days of hospitalization	10 (6 - 15)	14	0.149†
Days of inotropic drugs	1.5 (1 - 3)	2 (1 - 3)	0.239†
Days at ICU	4 (2 - 6)	4 (2 - 8)	0.341†

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[1] Corresponding author: Guillermo Kohn-Loncarica, Unidad Emergencias, Hospital de Pediatria “Prof. Dr. Juan P. Garrahan”, Pichincha 1885, Código Postal 1245, Buenos Aires, Argentina. E-mail:gkohnloncarica@gmail.com