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. 2022 Aug 1;23(8):618-625.
doi: 10.1097/PCC.0000000000002970. Epub 2022 Apr 21.

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

Robert A Levy  1 , Pamela D Reiter  2 , Matthew Spear  3 , Alison Santana  4 , Lori Silveira  5 , Shaina Cox  6 , Peter M Mourani  7 , Aline B Maddux  8
Affiliations

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

Robert A Levy et al. Pediatr Crit Care Med. .

Abstract

Objectives: Management of fluid refractory pediatric shock requires prompt administration of vasoactive agents. Although delivery of vasoactive therapy is generally provided via a central venous catheter, their placement can delay drug administration and is associated with complications. We characterize peripheral vasoactive administration in a cohort of critically ill children with shock, evaluate progression to central venous catheter placement, and describe complications associated with extravasation.

Design: Retrospective cohort study.

Setting: Single-center, quaternary PICU (January 2010 to December 2015).

Patients: Children (31 d to 18 yr) who received epinephrine, norepinephrine, or dopamine.

Interventions: None.

Measurements and main results: We compared patients based on the initial site of vasoactive infusion: peripheral venous access (PVA) or central venous access (CVA) and, within the PVA group, compared patients based on subsequent placement of a central catheter for vasoactive infusion. We also characterized peripheral extravasations. We evaluated 756 patients: 231 (30.6%) PVA and 525 (69.4%) CVA patients. PVA patients were older, had lower illness severity, and more frequently had vasoactive therapy initiated at night compared with CVA patients. In PVA patients, 124 (53.7%) had a central catheter placed after a median of 140 minutes (interquartile range, 65-247 min) of peripheral treatment. Patients who avoided central catheter placement had lower illness severity. Of the 93 patients with septic shock, 44 (47.3%) did not have a central catheter placed. Extravasations occurred in four of 231 (1.7% [95% CI, 0.03-3.4]) PVA patients, exclusively in the hand. Three patients received pharmacologic intervention, and none had long-term disabilities.

Conclusions: In our experience, peripheral venous catheters can be used for vasoactive administration. In our series, the upper limit of the 95% CI for extravasation is approximately 1-in-30, meaning that this route may be an appropriate option while evaluating the need for central access, particularly in patients with low illness severity.

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Conflict of interest statement

Dr. Mourani disclosed the off-label product use of Epinephrine, norepinephrine, and vasopressin. Dr. Maddux’s institution received funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23 HD096018); she received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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References

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