THE USE OF INOTROPIC AGENTS IN CHILDREN WITH SHOCK

Abstract

To evaluate the use of inotropic agents in the treatment of shock, the charts of 85 medical patients were reviewed. Each of the 85 hypotensive patients (MAP <2SD below the mean for age) were initially treated with dopamine (10 to 30μg/kg/min.). Sixty-seven patients responded to dopamine alone with a survival rate of 95%. However, 18 of 85 patients (21%), because of continued hypotension and/or inadequate urine output (<1.0cc/kg/hr.) on 30 μg/kg/min. of dopamine, were placed on epinephrine and the dopamine was discontinued. The dose of epinephrine ranged from 0.1 to 1.0μg/kg/min. While on epinephrine 3 of 18 patients (17%) did not improve with respect to arterial blood pressure or urine output; 10 of 18 patients (55%) showed a transient response, but later died from their illness; and 5 of 18 patients (28%) survived. A significant difference in the blood pressure, blood urea nitrogen, and the dose and duration of epinephrine therapy was observed between the survivors and the non-survivors after epinephrine. Significant changes in urine output were observed in both groups.

From this study, 28% of the patients who presented in shock and failed to respond to dopamine therapy did respond to a constant infusion of epinephrine with resolution of hypotension and ultimate survival. Therefore, epinephrine should be considered as a therapeutic modality in patients who are unresponsive to dopamine therapy.

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