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Which vasoactive drug should be first choice in paediatric septic shock?
  1. Steven McVea,
  2. Alastair Turner
  1. Paediatric Intensive Care, Royal Hospital for Children Glasgow, Glasgow, UK
  1. Correspondence to Dr Steven McVea, Paediatric Intensive Care, Royal Hospital for Children Glasgow, Glasgow G51 4TF, UK; steven.mcvea{at}btinternet.com

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Clinical scenario

A 6-year-old boy presents to Accident and Emergency with fever, lethargy and a spreading purpuric rash. Despite fluid resuscitation with 40 mL/kg he remains clinically shocked with tachycardia, cool peripheries, prolonged capillary refill time and lactic acidosis. Anaesthetics arrive to intubate and you as the paediatric registrar are asked to prescribe a peripheral vasoactive drug infusion. You remember that the advanced paediatric life support course you recently attended advised starting either dopamine or epinephrine in the setting of cold shock but wonder if there is evidence to support one over the other.

Structured clinical question

In children with septic shock unresponsive to 40 mL/kg fluid resuscitation (population) does initial peripheral venous administration of epinephrine (intervention) compared with dopamine (comparison) improve mortality (outcome)?

Search

We searched Ovid Medline on 20 June 2018 using the terms (paediatric OR pediatric OR child) AND (sepsis OR septic shock) AND (adrenaline or dopamine). In total, 89 papers were found and assessed, of which 17 qualified for further abstract review. Two were found to be relevant on review.1 2 Both results were randomised controlled trials and were subsequently analysed and graded according to the Oxford Centre for Evidence-based Medicine—Levels of Evidence (March 2009).3

Commentary

Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection.4 When severe, resultant circulatory insufficiency impairs systemic …

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