Application Of Vasoactive Medications In Children With Septic Shock In PICU Of Shandong Province From 2017 To 2021

Background:Septic shock is an important cause of death in pediatric intensive care units(PICU).The application of vasoactive medications is one of the important therapeutic measures for septic shock.In recent years,the Surviving Sepsis Campaign(SSC)guidelines have changed their recommendations on the preferred vasoactive medications for pediatric septic shock(PSS).As a province with a large population in China,there are no reports on the selection of vasoactive medications for PSS in PICU in Shandong Province.Objective:To investigate the application of vasoactive medications in PSS in a milticenter PICU in Shandong Province from 2017 to 2021,and to explore the factors affecting the prognosis of PSS in PICU.Methods:Clinical data of PSS aged>28 days and ≤18 years old admitted to participant PICUs between Jan 1,2017 and Dec 31,2021 as well as had ever received vasoactive medications were retrospectively collected and analyzed.And to analyze the factors influencing the mortality of PSS in the PICU.Results:(1)A total of 356 PSS were admitted to the participating units during the study period,aged 21.00(7,00,60.75)months,of whom 216(60.67%)were males,157(44.10%)had underlying disease,with an admission 24h-pSOFA score of 8.00(4.00,11.00)and a PRISM Ⅲ score of 12.00(7.00,17.00),with the respiratory system(41.57%)being the most common site of infection.(2)A total of 211 PSS were on vasoactive medications(59.27%),including 138 hypotensive PSS(65.40%)and 73 non-hypotensive PSS(34.60%).(3)The preferred application rate of vasoactive medications was norepinephrine,dopamine,dobutamine,epinephrine,milrinone and posterior pituitary hormone,in descending order,among which the highest preferred application rate was norepinephrine in hypotensive PSS,and dopamine was the most preferred in non-hypotensive PSS.(4)The most commonly used vasoactive medication changed from dopamine in 2017 to norepinephrine in 2021 of PSS,and the preferred application rate of dopamine showed a downward trend year by year.(5)The overall median initiation time of vasoactive medications was 1.33(0.00,6.88)h,which was significantly shorter in hypotensive PSS than that in non-hypotensive PSS(0.85(0.00,4.03)h vs 4.38(0.00,14.36)h,P<0.05).(6)The initiation time of vasoactive medications showed a significant trend of shortening from 6.88(1.17,19.78)h in 2017 to 0.87(0.00,4.77)h in 2021,P<0.05.(7)Combined respiratory failure,high number of organ damage and high PRISM Ⅲscores were independent risk factors affecting the prognosis of PS S in the PICU,and no effect of the use of vasoactive medications,type of preferred application and time of initiation was found on PICU mortality in PSS.Conclusions:Change in the most commonly preferred type of vasoactive medication applied to PSS in multicenter PICUs in Shandong Province from 2017 to 2021.It was adjusted from dopamine in 2017 to norepinephrine in 2021,and the change was basically in line with the recommendation of the guideline.This study did not find an effect of the application of vasoactive drugs,the preferred type of application,or the time of initiation on PICU morbidity and mortality in children with septic shock.