Peripheral Vasoactive Administration in Critically Ill Children With Shock: A Single-Center Retrospective Cohort...

Area of Science:

• Pediatric Critical Care Medicine
• Pharmacology
• Vascular Access

Background:

• Fluid-refractory pediatric shock necessitates prompt vasoactive agent administration.
• Central venous catheter placement, the traditional route, can delay treatment and lead to complications.

Purpose of the Study:

• To evaluate the safety and efficacy of peripheral vasoactive agent administration in critically ill children with shock.
• To assess the rate of central venous catheter placement following peripheral initiation.
• To describe complications, specifically extravasation, associated with peripheral vasoactive infusions.

Main Methods:

• Retrospective cohort study of 756 critically ill children (31 days to 18 years) receiving epinephrine, norepinephrine, or dopamine.
• Comparison of patients based on initial vasoactive infusion site: peripheral venous access (PVA) versus central venous access (CVA).
• Analysis of PVA patients for subsequent central catheter placement and characterization of peripheral extravasations.

Main Results:

• Of 756 patients, 231 (30.6%) received initial vasoactive therapy via PVA. PVA patients were older, had lower illness severity, and were more likely to start therapy at night.
• In the PVA group, 53.7% subsequently had a central catheter placed after a median of 140 minutes.
• Extravasation occurred in 1.7% of PVA patients, with no long-term disabilities reported.

Conclusions:

• Peripheral venous catheters can be safely used for vasoactive agent administration in pediatric shock.
• The low rate of extravasation suggests PVA is a reasonable option, especially for patients with lower illness severity, while central access is being established.
• This approach may reduce delays in initiating critical vasoactive therapy.