Abstract
BackgroundReversal of hypotension is a priority in the management of a collapsed child. The pediatric Surviving Sepsis Campaign advocates for the rapid use of epinephrine or norepinephrine for sepsis related myocardial or vascular dysfunction following 40-60ml/kg of fluid resuscitation. Vasoactive drugs should be started within the first hour after sepsis recognition in a patient with shock. In such a short delay, central venous access can be difficult to obtain, and infusion may be initially started through a peripheral catheter. Hereby, we reported the safety of norepinephrine infusion through a peripheral catheter in retrieved shocked patients.MethodsMulticentric retrospective analysis of medical pediatric retrieval teams experience of vasopressors infusion through a peripheral vascular access. Medical pediatric retrieval teams (SMUR) and Pediatric Intensive care units (PICU) of the Paris urban region. Children 0 to 18 years necessitating norepinephrine infusion during retrieval. Modalities of infusion (drip concentration, duration, site of infusion), incidence of complication and outcome at PICU discharge were reviewed.ResultsThirty-seven children in shock received a norepinephrine infusion for a median time of 4 hours. No local adverse event was noted. One patient had transient blanching of the skin which improved after appropriate care. The overall mortality was 10.8% with one death (2.7%) during transport and 3 (8.1%) in PICU. ConclusionsDuring transport of critically ill patients requiring vasopressor infusion by a specialized pediatric retrieval team, the use of norepinephrine on a non-central catheter was safe among all patients.
Safety of early norepinephrine infusion through peripheral vascular access during transport of critically ill children
