Noradrenaline use for septic shock in children: doses, routes of administration and complications
Article first published online: 28 MAY 2012
© 2012 The Author(s)/Acta Pædiatrica © 2012 Foundation Acta Pædiatrica
Volume 101, Issue 9, pages e426–e430, September 2012
How to Cite
Lampin, M., Rousseaux, J., Botte, A., Sadik, A., Cremer, R. and Leclerc, F. (2012), Noradrenaline use for septic shock in children: doses, routes of administration and complications. Acta Paediatrica, 101: e426–e430. doi: 10.1111/j.1651-2227.2012.02725.x
- Issue published online: 3 AUG 2012
- Article first published online: 28 MAY 2012
- Accepted manuscript online: 8 MAY 2012 11:31AM EST
- Received 10 March 2012; revised 27 April 2012; accepted 3 May 2012.
- septic shock;
- severe sepsis
Aim: To report our 10 year experience with noradrenaline use in children with septic shock focusing on doses, routes of administration and complications.
Methods: Retrospective single-centre review of children with septic shock who received noradrenaline between 2000 and 2010.
Results: We identified 144 children with septic shock treated with noradrenaline, in 22% as the first-line drug. The median volume resuscitation before vasoactive agent administration was 50 mL/kg interquartile range [IQR: 30–70]. Mean doses of noradrenaline ranged from 0.5 ± 0.4 μg/kg per min (starting dose) to 2.5 ± 2.2 μg/kg per min (maximum dose). Noradrenaline was administered via peripheral venous access or intra-osseous route in 19% of cases for a median duration of 3 h [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 two children and hypertension in eight children. None of these arrhythmias required treatment and hypertension resolved with the noradrenaline dose reduction.
Conclusion: 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.