Haemodynamic Parameters: Comparative Study between Dopamine, Norepinpherine and Milrinone in Critically ill Children with Septic Shock at Ain Shams University Pediatric Intensive Care Unit

Abstract

Pediatric sepsis represents an important cause of mortality in pediatric intensive care units (PICU) and one of the leading causes of childhood mortality worldwide. Cardiovascular dysfunction is a central component of the multiple organ dysfunction syndrome, an often fatal sequel of severe sepsis and septic shock. Bedside transthoracic echocardiography can rapidly and accurately assess cardiac function, allowing the clinician to determine the need for inotropic support in the face of the dynamic clinical situation in septic shock. This is a case-control study aimed to evaluate and compare the efficacy of norepinephrine, dopamine and milrinone in reversing the haemodynamic abnormalities in critically ill pediatric patient with septic shock by using transthoracic echocardiography. The study was conducted in the Pediatric Intensive Care Unit, Children's Hospital, Ain Shams University during the period from December 2013 to January 2015. It included 90 critically ill patients with septic shock who were diagnosed according to the clinical manifestation and 90 healthy children were also included as a control group. All patients were be subjected to: 1. Full history taking laying stress on: age, sex, history of repeated infection, co-morbid disease, previous invasive medical procedures and family history of immune deficiency. 2. Clinical Examination laying stress on: - Mental status: Restless, agitated, anxious, progressive lethargy. - Skin: Temperature, color, turgor, any rash may be present or signs of trauma. - Cardiac examination and heart rate monitoring. - Chest examination stressing on respiratory rate. - Blood pressure monitoring. - Urine output monitoring 3. The risk of mortality was detected in the diseased population by applying the Pediatric Index of Mortality Score (PIM) 4. All patients received appropriate fluid resuscitation and appropriate antibiotics and were randomly categorized according to the type of the used vasoactive agent into.  Group "I": patients who received dopamine infusion in a dose that ranged between 5-20 µg/kg/min tirated according to patient’s response  Group "II": patients who received norepinephrine infusion in a dose that ranged between 0.1 -1.2 µg/kg/min titrated according to patient’s response.  Group "III": patients who received milrinone infusion in a dose that ranged between 0.25-0.75 µg/kg titrated according to patient’s condition. 5. ECG to exclude any abnormality in the cardiac rhythm. 6. Tranthoracic echocardiography was done for the patients group using portable echocardiography machine (VIVID I, N-3190 Horten, Norway SN 00064 GE vingmed ultrasound) and transducer Probe (5S-RS matrix GE ultrasound SN 60417PD3 USA, 2.25 – 4.75 MHz) and it was also done for the control group using the (Vivid E 9, Norway SN 1246 GE vingemed ultrasound China) and the probe (M5Sc-D GE ultrasound SN000002821 China, 2–4.6 MHZ): Examination included 2 dimensional (2D), M mode (M-mode), color Flow Doppler (CFD), continous wave (CW) and Pulsed wave (PW) Doppler. 7. The collected data was revised, coded, tabulated and introduced to a PC using Statistical package for Social Science (SPSS 15.0.1 for windows; SPSS Inc, Chicago, IL, 2001).