Clinical outcome of children with fluid-refractory septic shock treated with dopamine or epinephrine. A retrospective study at a pediatric emergency department in Argentina

Kohn-Loncarica, Guillermo; Fustiñana, Ana; Santos, César; Lantelli, Guadalupe Paniagua; Rowensztein, Hernán; González‐Dambrauskas, Sebastián

doi:10.5935/0103-507x.20200092

Cited by 5 publications

(3 citation statements)

References 19 publications

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“…Determinando así, que ambos fármacos son útiles en el tratamiento de varias patologías que requieren vasoactivos, en este caso la utilidad se vio en el tratamiento del shock séptico en niños. 12 La utilización de la escala de vasoactivos inotrópicos independiente como predictor de mortalidad hospitalaria en pacientes con shock cardiogénico fue alta, sin embargo, en aquellos pacientes tratados con oxigenación por membrana extracorpórea y altas concentraciones de vasopresores el índice fue bajo, por lo cual se recomienda evaluar anticipadamente el riesgo-beneficio del tratamiento antes de aplicarlo. 13 14 El utilizar el biomarcador NT-proBNP y el puntaje inotrópico vasoactivo, podría ser útil en el pronóstico del paciente con falla cardiaca.…”

Section: Resultsunclassified

Cuidado de enfermería en la administración de fármacos vasoactivos en urgencias

Villa-Solis,

Ortega-Guevara,

Hernandez-Zambrano

et al. 2023

Vida y Salud

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Objetivo: analizar el cuidado de enfermería en la administración de fármacos vasoactivos en urgencias. Método: Revisión sistemática en 15 articulos científicos. Resultados y conclusiones: La utilización de estos medicamentos vasoactivos dependerá del estado hemodinámico, sistémico y autorregulador del paciente, por tales razones el personal de enfermería tiene la obligación de conocer el funcionamiento de estos medicamentos en patologías que requieran de tal uso, como por ejemplo en el shock séptico en donde se los usa por la afectación al eje tiroideo de T3 o en mujeres embarazadas, en dónde se debe estar preparado para aplicar el tratamiento adecuado en caso de hipotensión debido a la gravedad de las consecuencias que ello conlleva tanto en la madre como en el feto.

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Section: Resultsunclassified

Cuidado de enfermería en la administración de fármacos vasoactivos en urgencias

Villa-Solis,

Ortega-Guevara,

Hernandez-Zambrano

et al. 2023

Vida y Salud

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“…[18][19][20] Our study showed good adherence to this recommendation as most children were treated with epinephrine instead of dopamine. Dopamine has historically been the drug of choice for the treatment of fluid-refractory PSS 20,61,62 ; however, recent studies have shown superiority of epinephrine over dopamine. [63][64][65][66] The replacement of dopamine by epinephrine may be an easier intervention compared with other more time-sensitive goals.…”

Section: Discussionmentioning

confidence: 99%

Adherence to Pediatric Sepsis Treatment Recommendations at Emergency Departments

Fustiñana¹,

Yock‐Corrales²,

Casson³

et al. 2022

Pediatr Emer Care

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Objective: Sepsis is one of the most urgent health care issues worldwide.Guidelines for early identification and treatment are essential to decrease sepsis-related mortality. Our aim was to collect data on the epidemiology of pediatric septic shock (PSS) from the emergency department (PED) and to assess adherence to recommendations for its management in the first hour.Methods: A multicenter, prospective, cross-sectional study was conducted evaluating children with PSS seen at the PED of 10 tertiary-care centers in Latin America. Adherence to guidelines was evaluated. Results:We included 219 patients (median age, 3.7 years); 43% had comorbidities, 31% risk factors for developing sepsis, 74% clinical signs of "cold shock," and 13% of "warm shock," 22% had hypotension on admission. Consciousness was impaired in 55%. A peripheral line was used as initial access in 78% (median placement time, 10 minutes). Fluid and antibiotics infusion was achieved within a median time of 30 minutes (interquartile range [IQR], 20-60 minutes) and 40 minutes (IQR, 20-60 minutes), respectively; 40% responded inadequately to fluids requiring vasoactive drugs (median time at initiation, 60 minutes; IQR, 30-135 minutes). Delay to vasoactive drug infusion was significantly longer when a central line was placed compared to a peripheral line (median time, 133 minutes [59-278 minutes] vs 42 minutes [30-70 minutes], respectively [P < 0.001]). Adherence to all treatment goals was achieved in 13%. Mortality was 10%. An association between mortality and hypotension on admission was found (26.1% with hypotension vs 4.9% without; P < 0.001).

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“…There may also be age-related differences in how immune cells and the cardiovascular system respond to dopamine, which need to be further explored. In addition, a number of studies show that dopamine treatment is as safe and effective as other treatments, and randomized trials in neonates and pediatric patients who were septic and treated with dopamine or epinephrine showed no difference in long-term mortality and comparable efficacy and safety ( Baske et al, 2018 ; Kohn-Loncarica et al, 2020 ). In patients treated with norepinephrine, dopamine, or a combination of norepinephrine and vasopressin, the recommended vasoactive therapy for sepsis, dopamine shortened intensive care unit and hospital stays compared with the other therapies ( Zhou, Zhu et al, 2021 ).…”

Section: Regional and Disease-specific Effects Of Dopaminementioning

confidence: 99%

Dopamine, Immunity, and Disease

et al. 2022

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The neurotransmitter dopamine is a key factor in central nervous system (CNS) function, regulating many processes including reward, movement, and cognition. Dopamine also regulates critical functions in peripheral organs, such as blood pressure, renal activity, and intestinal motility. Beyond these functions, a growing body of evidence indicates that dopamine is an important immunoregulatory factor. Most types of immune cells express dopamine receptors and other dopaminergic proteins, and many immune cells take up, produce, store, and/or release dopamine, suggesting that dopaminergic immunomodulation is important for immune function. Targeting these pathways could be a promising avenue for the treatment of inflammation and disease, but despite increasing research in this area, data on the specific effects of dopamine on many immune cells and disease processes remain inconsistent and poorly understood. Therefore, this review integrates the current knowledge of the role of dopamine in immune cell function and inflammatory signaling across systems. We also discuss the current understanding of dopaminergic regulation of immune signaling in the CNS and peripheral tissues, highlighting the role of dopaminergic immunomodulation in diseases such as Parkinson’s disease, several neuropsychiatric conditions, neurologic human immunodeficiency virus, inflammatory bowel disease, rheumatoid arthritis, and others. Careful consideration is given to the influence of experimental design on results, and we note a number of areas in need of further research. Overall, this review integrates our knowledge of dopaminergic immunology at the cellular, tissue, and disease level and prompts the development of therapeutics and strategies targeted toward ameliorating disease through dopaminergic regulation of immunity. Significance Statement Canonically, dopamine is recognized as a neurotransmitter involved in the regulation of movement, cognition, and reward. However, dopamine also acts as an immune modulator in the central nervous system and periphery. This review comprehensively assesses the current knowledge of dopaminergic immunomodulation and the role of dopamine in disease pathogenesis at the cellular and tissue level. This will provide broad access to this information across fields, identify areas in need of further investigation, and drive the development of dopaminergic therapeutic strategies.

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Clinical outcome of children with fluid-refractory septic shock treated with dopamine or epinephrine. A retrospective study at a pediatric emergency department in Argentina

Cited by 5 publications

References 19 publications

Cuidado de enfermería en la administración de fármacos vasoactivos en urgencias

Cuidado de enfermería en la administración de fármacos vasoactivos en urgencias

Adherence to Pediatric Sepsis Treatment Recommendations at Emergency Departments

Dopamine, Immunity, and Disease

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