Management of the changeover of inotrope infusions in children

Abstract

Inotropes are drugs that can assist the critically ill patient's heart to function more effectively by increasing contractility. Inotrope infusions are run continuously and fresh infusions are required on a regular basis. The two methods of changeover commonly used are the quick-change and the double-pump methods. Haemodynamic compromise can occur to some degree with both methods. Evidence regarding the most effective method is limited to individual experience and anecdote. Therefore, the aim of this project was to determine the best method of changing inotropic infusions in children.

Methods: Thirty children receiving inotropes post-cardiac surgery admitted to PICU were included in the study. There were two methods of changing over inotropes in this study: Method 1, quick-change and Method 2, double infusion. A rescue bolus of 0.1 ml of the changeover inotrope was given for drops in mean arterial pressure (MAP) > or = 20% during the changeover period.

Results: Repeated measures analysis for MAP demonstrated no significant difference in the mean percentage change from baseline during the 30-min changeover period. Quick-change: -0.297 (95% CI: -6.43 to 0.5) and double-pump: 3.73 (95% CI: -2.81 to 10.27) (P = 0.078).

Conclusions: There was no statistically or clinically significant difference detected in changes to MAP. A rescue bolus was required on only one occasion during quick-change over for a reduction in MAP of > or = 20% in the quick-change group. Therefore, a quick-change method can be considered more effective as it reduces the time required for changeover and the risk of tolerance to higher levels of inotrope, while maintaining haemodynamic stability in children after cardiac surgery.