Hypotension and Shock Clinical Trial
Official title:
Role of Low Dose Epinephrine Boluses For Acute Hypotension in The Pediatrics ICU
The Study evaluates the role of low dose epinephrine boluses in management of acute
hypo-tension VS The Traditional management of acute hypo-tension.
Half of the participants suffering from acute hypo-tension will receive low dose epinephrine
boluses (≤ 5 µg/kg/dose) and the other half will receive traditional management of shock
Epinephrine, due to its alpha-1 and beta-adrenergic effects, is considered an important part
of the management of children with hypo-tension. Epinephrine is typically used as a
continuous infusion (0.02-0.5 μg/kg/min) for severe sustained hypo-tension and as a bolus
(0.01 mg/kg, maximum dose = 1 mg) for bradycardia, asystole, or pulse-less arrest. There are,
however, clinical conditions that may benefit from smaller doses of bolus epinephrine. For
example, brief periods of hypo-tension during medical procedures, intermittent hemodynamic
instability, and augmentation of low blood pressure in a pre-arrest condition. While a
resuscitation (or code) dose of epinephrine would be inappropriate (as it would cause an
unacceptable large increase in blood pressure and heart rate [HR]), a smaller dose may be
particularly useful.
Low-dose bolus vasopressors have been used for decades by anaesthesiologists to prevent
post-re-perfusion injury after solid organ transplant, control cerebral oxygenation during
anaesthesia and manage acute hypo-tension during spinal surgery. Recently, use of bolus dose
phenyl-ephrine has been described in the emergency department setting to augment blood
pressure during periods of hypo-tension surrounding intubation. Finally, free open access
medical publications have provided some insight into using bolus dose pressors for acute
hypotensive episodes in adults. However, there is few published data describing the use of
low-dose vasopressor boluses in children.
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