Efectos de la asociación vasopresina-noradrenalina en pacientes pediátricos con choque séptico refractario

Abstract

Objective:To evaluate the effect on mean arterial pressure (MAP), hospital stay, mortality and tissue perfusion with the use of vasopressors in children with refractory septic shock in the pediatric intensive care unit of Cardioinfantil Foundation. Materials and Methods: A retrospective observational cohort study of children aged 1 month to 18 years with refractory septic shock served from January 2008 to December 2013 treated with norepinephrine alone or vasopressin-noradrenaline. Patients with shock due to other causes, congenital heart defects, diabetes insipidus and brain death were excluded. As a measure of association relative risks with confidence intervals at 95% were estimated. Results: 129 patients, of whom 51% are boys, average age 52 months with an overall mortality of 34.1% were evaluated. The baseline MAP in both groups showed significant increase and was maintained in the next 3 hours (p<0,005). The mortality in the mild risk group of PRISM III was lower with norepinephrine alone (p <0,005; RR3,7 95% CI 1,16 - 12,2) but equal in both groups at moderate risk according to this scale (p=0,42 RR 0.88 95% CI 0.60 - 1.30). Were found no statistically significant differences in the total stay in PICU (p = 0,79) or hospital (p=0,96) but improved liver (p = 0.004) and kidney function (p <0,005) in the group of vasopressin-noradrenaline. Conclusions: Association vasopressin-noredrenaline improves PAM when goals are not achieved with one vasopressor in patients with refractory septic shock. Prospective studies are needed to corroborate these findings. Keywords: refractory septic shock, norepinephrine, vasopressin, mortality.