Safety of early norepinephrine infusion through peripheral vascular access during transport of critically ill children

Charbel, Ramy; Ollier, Vincent; Julliand, Sebastien; Jourdain, G.; Lodé, N.; Tissières, Pierre; Morin, Luc

doi:10.1002/emp2.12395

Cited by 12 publications

(6 citation statements)

References 7 publications

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“…A small subgroup of 20 children, mostly with septic shock, received an infusion of peripheral norepinephrine for a median time of 660 minutes without the development of extravasation injury. This observation is consistent with findings of Lampin et al (18) and, more recently, Charbel et al (19), who describe 37 children receiving norepinephrine for a median duration of 240 minutes with one extravasation event.…”

Section: Discussionsupporting

confidence: 92%

Peripheral and Central/Intraosseous Vasoactive Infusions During and After Pediatric Critical Care Transport: Retrospective Cohort Study of Extravasation Injury*

Peshimam¹,

Bruce-Hickman²,

Crawford³

et al. 2022

Pediatric Critical Care Medicine

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To compare the prevalence of adverse events related to vasoactive drug infusions administered via a peripheral venous catheter versus a central venous or intraosseous catheter.DESIGN: Retrospective observational study. SETTING:A pediatric critical care transport team, and the PICUs and regional hospitals within the North Thames and East Anglia regions of the United Kingdom. PATIENTS:Children (up to 18 yr old) transported by the Children's Acute Transport Service receiving an infusion of a vasoactive drug (epinephrine, dobutamine, dopamine, norepinephrine, and vasopressin). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:The medical records of all children transported between April 2017 and May 2020 receiving a vasoactive drug infusion were reviewed and cross-referenced with the service critical incident database. The outcome measure was anatomic catheter-related adverse events (including extravasation) reported during transport or in the first 24 hours on the PICU. During the study period, the service undertook 3,836 transports. Vasoactive drugs were administered during 558 patient transports (14.5%). During 198 of 558 transports (35.5%), vasoactive drugs were administered via a peripheral venous catheter, with seven of 198 (3.5%) adverse events. One extravasation event resulted in tissue necrosis. The median time to injury after the infusion was commenced was 60 minutes (interquartile range, 30-60 min). During 360 of 558 transports (64.5%), vasoactive infusions were administered by central venous or intraosseous catheter, with nine of 360 (2.5%) adverse events. CONCLUSIONS:During pediatric critical care transport, we did not find a difference in prevalence of adverse events following the administration of vasoactive drugs via peripheral venous catheters or via central venous and intraosseous catheters.

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Section: Discussionsupporting

confidence: 92%

Peripheral and Central/Intraosseous Vasoactive Infusions During and After Pediatric Critical Care Transport: Retrospective Cohort Study of Extravasation Injury*

Peshimam¹,

Bruce-Hickman²,

Crawford³

et al. 2022

Pediatric Critical Care Medicine

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“…For fluid resuscitation, including transfusion of blood products, the flow rates of IO accesses are limited, and at least two peripheral IV lines are recommended, while the size of the cannulas should be large enough to deliver appropriate volumes rapidly [ 1 , 2 , 5 , 6 , 37 ]. Recent studies revealed that continuous administration of vasopressor agents through peripheral IV lines is feasible and safe [ 38 , 39 , 40 ]. However, special attention should be paid to the patency, functionality and securement of peripheral IV lines to avoid extravasation injuries.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological Analysis of the Emergency Vascular Access in Pediatric Trauma Patients: Single-Center Experience of Intravenous, Intraosseous, Central Venous, and Arterial Line Placements

et al. 2023

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Vascular access in severely injured pediatric trauma patients is associated with time-critical circumstances and low incidences, whereas only scarce literature on procedure performance is available. The purpose of this study was to analyze the performance of different vascular access procedures from the first contact at the scene until three hours after admission. Intubated pediatric trauma patients admitted from the scene to a single Level I trauma center between 2008 and 2019 were analyzed regarding intravenous (IV) and intraosseous (IO) accesses, central venous catheterization (CVC) and arterial line placement. Sixty-five children with a median age of 14 years and median injury severity score of 29 points were included, of which 62 (96.6%) underwent successful prehospital IV or IO access by emergency medical service (EMS) physicians, while it failed in two children (3.1%). On emergency department (ED) admission, IV cannulas of prehospital EMS had malfunctions or were dislodged in seven of 55 children (12.7%). IO access was performed in 17 children without complications, and was associated with younger age, higher injury severity and higher mortality. Fifty-two CVC placements (58 attempts) and 55 arterial line placements (59 attempts) were performed in 45 and 52 children, respectively. All CVC and arterial line placements were performed in the ED, operating room (OR) and intensive care unit (ICU). Ten mechanical complications related to CVC placement (17.8%) and seven related to arterial line placement (10.2%) were observed, none of which had outcome-relevant consequences. This case series suggests that mechanical issues of vascular access may frequently occur, underlining the need for special preparedness in prehospital, ED, ICU and OR environments.

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“…11 Preterm neonates born less than 37 gestational weeks are often selected against NE because they are evidenced to present the following: (1) a higher catecholamine level, indicating a presumably weaker response to NE 12 13 ; (2) increased risk of pulmonary hypertension after NE 14 ; (3) an increased vascular resistance and decreased organ perfusion (previously reviewed 15 16 ); and (4) risk of extravasation and skin injury with NE infusion. 17 NE is currently used in less than 5% of preterm neonates with shock 3 as a second-line or third-line treatment. 18 Recent studies have suggested that the adverse events of NE are generally tolerated, and improved haemodynamics after NE can be observed in preterm neonates with septic shock or cardiovascular compromise.…”

Section: What This Study Addsmentioning

confidence: 99%

“…In addition, previous studies in adults showed that dopamine administration might be associated with increased mortality in shock10 or similar outcomes but higher adverse events 11. Preterm neonates born less than 37 gestational weeks are often selected against NE because they are evidenced to present the following: (1) a higher catecholamine level, indicating a presumably weaker response to NE12 13; (2) increased risk of pulmonary hypertension after NE14; (3) an increased vascular resistance and decreased organ perfusion (previously reviewed15 16); and (4) risk of extravasation and skin injury with NE infusion 17. NE is currently used in less than 5% of preterm neonates with shock3 as a second-line or third-line treatment 18…”

Section: Introductionmentioning

confidence: 99%

Use of norepinephrine in preterm neonates with dopamine-resistant shock: a retrospective single-centre cross-sectional study

Gong

et al. 2023

bmjpo

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BackgroundNorepinephrine (NE) is recommended for children and full-term neonates (born at >37 gestational weeks) with septic shock. Meanwhile, data on the effectiveness of NE in preterm neonates are still limited. This study aimed to evaluate the clinical efficacy of NE in preterm neonates with dopamine-resistant shock compared with that in full-term neonates.MethodsThis was a single-centre, retrospective (January 2010–December 2020) cohort study of neonates with persistent shock despite adequate fluid resuscitation and dopamine or dobutamine administration at ≥10 μg/kg/min. Medical records of neonates treated with NE were retrospectively reviewed to collect respiratory and haemodynamic parameters and results of arterial blood gas (ABG) tests before and 8 hours after NE infusion. The effectiveness of NE was assessed using changes in clinical parameters and multiple regression models for mortality among subgroups of preterm and full-term neonates.ResultsNinety-two neonates (76% preterm) who received NE infusion were included in the study. NE infusion was started after a median of 7 hours (IQR 2–19 hours) after shock onset. Among the preterm neonates, the maximum dose of NE infusion was 0.5 (IQR 0.3–1.0) µg/kg/min with a median duration of 45 (IQR 24.0–84.5) hours. Haemodynamic dysfunction was ameliorated with increased blood pressure, decreased heart rate and improved ABG results. Preterm neonates with septic shock tended to have a reduced response to NE; however, preterm neonates with persistent pulmonary hypertension of the newborn tended to have a better response. Thirty-four (37%) neonates died in our cohort. The timing, dose and duration of NE use were not associated with neonatal mortality.ConclusionsAlthough using NE effectively improves clinical parameters in preterm neonates with dopamine-resistant shock, our study is underpowered to identify the association between NE infusion and mortality in preterm neonates with dopamine-resistant shock.

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Safety of early norepinephrine infusion through peripheral vascular access during transport of critically ill children

Cited by 12 publications

References 7 publications

Peripheral and Central/Intraosseous Vasoactive Infusions During and After Pediatric Critical Care Transport: Retrospective Cohort Study of Extravasation Injury*

Peripheral and Central/Intraosseous Vasoactive Infusions During and After Pediatric Critical Care Transport: Retrospective Cohort Study of Extravasation Injury*

Epidemiological Analysis of the Emergency Vascular Access in Pediatric Trauma Patients: Single-Center Experience of Intravenous, Intraosseous, Central Venous, and Arterial Line Placements

Use of norepinephrine in preterm neonates with dopamine-resistant shock: a retrospective single-centre cross-sectional study

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