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Published on: September 11, 2018
Norepinephrine infusion increases urine output in children under sedative and analgesic infusion
Jefferson Piva1, Tamila Alquati2, Pedro Celiny Garcia2
1Pediatric Emergency and Intensive Care Department, Hospital de Clínicas de Porto Alegre, UFRGS University, Porto Alegre, RS, Brazil.
Insights
Early norepinephrine (NE) infusion in mechanically ventilated children improved blood pressure and urine output. This intervention may counteract vasoplegia caused by sedative and analgesic drugs.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
Background:
- Mechanical ventilation (MV) in children often requires continuous sedative and analgesic infusions.
- These infusions can induce vasoplegia, affecting hemodynamic stability.
- Optimizing hemodynamic management in this population is crucial.
Purpose of the Study:
- To assess the impact of early norepinephrine (NE) infusion on children undergoing mechanical ventilation.
- To evaluate hemodynamic variables, fluid balance, and renal function in this context.
Main Methods:
- A double-blinded, randomized, placebo-controlled trial was conducted in a Brazilian Pediatric Intensive Care Unit (PICU).
- Children aged 1 month to 12 years requiring MV and sedation for at least five days were enrolled.
- Participants received either NE (0.15 mcg/kg/min) or normal saline for 72 hours, initiated within 24 hours of MV.
Main Results:
- Forty children were randomized; no significant differences in baseline characteristics or outcomes like mortality were observed.
- The NE group demonstrated significantly higher urine output (p = 0.016).
- Mean arterial pressure showed a significant continuous increment in the NE group compared to baseline (p = 0.043).
Conclusions:
- Early administration of norepinephrine in mechanically ventilated children receiving sedatives and analgesics improves mean arterial pressure.
- Norepinephrine infusion also led to increased urine output in this pediatric cohort.
- These findings suggest NE can effectively reverse vasoplegia induced by sedative and analgesic agents.
Objective:
To evaluate the effects of early norepinephrine (NE) infusion in children submitted to mechanical ventilation (MV) requiring continuous sedative and analgesic infusion.
Methods:
Double-blinded, randomized, placebo-controlled trial enrolling children (1 month to 12 years of age) admitted to a Brazilian PICU and expected to require MV and continuous sedative and analgesic drug infusions for at least five days. Children were randomized to receive either norepinephrine (NE) (0.15 mcg/kg/min) or normal saline infusion, started in the first 24 hours of MV, and maintained for 72 hours. We compared hemodynamic variables, fluid intake, renal function and urine output between groups.
Results:
Forty children were equally allocated to the NE or placebo groups, with no differences in baseline characteristics, laboratorial findings, PRISM II score, length of MV, or mortality between groups. The average norepinephrine infusion was 0.143 mcg/kg/min. The NE group showed higher urine output (p = 0.016) and continuous increment in the mean arterial pressure compared to the baseline (p = 0.043). There were no differences in the remaining hemodynamic variables, fluid requirements, or furosemide administration.
Conclusion:
Early norepinephrine infusion in children submitted to MV improves mean arterial pressure and increases urine output. These effects were attributed to reversion of vasoplegia induced by the sedative and analgesic drugs.
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