TABLE 2.
Outcomes and Organ Dysfunction in the Study Population
| Variable | Norepinephrine Plus Dobutamine Group (n = 34) | Epinephrine Group (n = 33) | Risk Ratio/Mean Difference (95% CI) | p |
|---|---|---|---|---|
| Primary outcome | ||||
| Proportion achieving shock resolution at 1 hr, n (%) | 6 (17.6) | 3 (9) | 2 (0.54–7.35) | 0.25 |
| Secondary outcomes | ||||
| Proportion achieving shock resolution at 6 hr, n (%) | 26 (76.4) | 18 (54.5) | 1.69 (0.92–3.13) | 0.06 |
| Proportion achieving shock resolution at 24 hr, n (%) | 33 (97.1) | 28 (84.8) | 1.14 (0.97–1.33) | 0.08 |
| 28-d mortality, n (%) | 8 (23.5) | 13 (39.3) | 0.59 (0.28–1.25) | 0.16 |
| Time to attain shock resolution (hr), median (IQR) | 3 (2–6) | 6 (3–10) | 1.84 (1.1–3.08)a | 0.02 |
| Duration of vasoactive therapy (hr), median (IQR) | 52 (25–146) | 65 (40–124) | 1.21 (0.7–2.08)a | 0.5 |
| Other vasoactive agents added, n (%) | 10 (29.4) | 27 (82) | 2.78 (1.61–4.80) | < 0.001 |
| Dopamine | 3 (9) | 9 (27) | 1.15 (0.39–3.41) | 0.82 |
| Dobutamine | NA | 21 (64) | NA | NA |
| Milrinone | 6 (18) | 11 (33) | 0.71 (0.36–1.39) | 0.34 |
| Vasopressin | 2 (6) | 5 (26) | 0.96 (0.22–4.18) | 0.96 |
| Levosimendan | 1 (3) | 2 (6) | 0.77 (0.08–7.57) | 0.82 |
| Norepinephrine in the epinephrine group | NA | 13 (39) | NA | |
| Epinephrine in the norepinephrine group | 7 (21) | NA | NA | NA |
| Fluids administered | ||||
| Volume of fluid boluses received before starting inotropes (mL/kg) | 40 (20–40) | 40 (20–40) | NA | 0.97 |
| Volume of fluid boluses received after starting inotropes (mL/kg) | 20 (20–30) | 20 (10–30) | NA | 0.74 |
| Volume of fluids received in 24 hr (mL/kg) | 75 (60–91) | 84 (60–96) | NA | 0.58 |
| Cumulative fluid balance till shock resolution (%) | 3.3 (1.2–4.3) | 4.1 (0.3–6.4) | NA | 0.34 |
| Adverse events | ||||
| Rhythm abnormalities, n (%) | 2 (5.8) | 4 (12.1) | NA | 0.32 |
| Arterial gangrene, n (%) | 0 (0) | 1 (3) | NA | 0.49 |
| Duration of PICU stay (d), median (IQR) | 10 (6–14) | 6 (5–13) | 1.19 (0.77–1.85)b | 0.43 |
| Duration of hospital stay (d), median (IQR) | 19 (10–29) | 15 (9–28) | 1.03 (0.70–1.52)b | 0.88 |
| Organ dysfunction and support | ||||
| Ventilation, n (%) | 23 (68) | 28 (85) | NA | 0.18 |
| Duration of mechanical ventilation, median (IQR) | 8 (6–12) | 6.5 (3.2–19) | 1.34 (0.79–2.35)b | 0.28 |
| Proportion with septic myocardial dysfunction, n (%) | 15 (44.1) | 14 (42.4) | 1.03 (0.67–1.56) | 0.88 |
| Proportion receiving hydrocortisone for catecholamine refractory shock, n (%) | 15 (45) | 15 (44) | 1.03 (0.60–1.75) | 0.91 |
| Packed RBC transfusion, n (%) | 22 (64.7) | 21 (63.6) | NA | 0.92 |
| Renal replacement therapy, n (%) | 7 (20.5) | 9 (27.2) | NA | 0.52 |
| Pediatric Sequential Organ Failure Assessment, median (IQR) | ||||
| Day 1 | 8.5 (5–11) | 9 (8–12) | NA | 0.59 |
| Day 2 | 8 (5–10) | 9 (8–11) | 0.04 | |
| Day 3 | 6 (3–10) | 8 (5–10) | 0.1 | |
| Pediatric Logistic Organ Dysfunction-2, median (IQR) | ||||
| Day 1 | 6 (2–9) | 8 (5–10) | NA | 0.09 |
| Day 2 | 4 (2–7) | 6 (4–7.5) | 0.05 | |
| Day 3 | 4.5 (2–7) | 5 (4–8) | 0.13 | |
IQR = interquartile range, NA = not applicable.
a
Hazard ratio.
b
Quasi-Poisson regression coefficient.