Inotrope use in children with septic shock: a guide for general paediatricians

Abstract

Administering inotropes early in children with septic shock who do not respond to fluid resuscitation is important. Epinephrine and norepinephrine are the best available options in patients with non-complex pathology, but dopamine can be used if they are not available. Some basic understanding of the underlying physiology is vital in tailoring the best choice of inotrope. When the decision to start inotropes is made, we need to frequently assess the haemodynamic status of our patient, titrate the inotropes carefully and be alert to other factors that may affect cardiovascular function (figure 3).Despite the lack of evidence, physicians at the bedside must make decisions. Our article provides a pragmatic approach to inotropic support for children with sepsis as it combines up-to-date evidence with the practice employed by numerous UK-based paediatric critical care retrieval teams.Seeking advice about children in septic shock from the regional critical care retrieval service is crucial. It is safe to use peripheral inotropes while waiting for the retrieval team’s arrival. Where the skill sets for central venous and arterial access as well as focused echocardiography exist, these should be performed as they will further help optimise management.There is clearly still a need for higher quality evidence for inotropic use in the paediatric population. As research advances, the balance between safety and efficacy of inotropes and the relationships between short-term inotropic effects and long-term outcomes will hopefully become clearer.