COMPARISON OF EFFICACY OF DOPAMINE AND ADRENALINE FOR TREATMENT OF FLUID REFRACTORY SEPTIC SHOCK IN CHILDREN

Abstract

Introduction: There are currently no set standards for the first vasoactive medication to be given to children who are in fluid-refractory septic shock.  Each institution has up until now been allowed to choose the first vasoactive drug in these circumstances.  This is because there is a dearth of international research on the relative efficacy of inotropes in this type of clinical situation, particularly in Pakistan.  By carrying out a preliminary investigation, this study aims to close the gap in this field.

Materials & Methods: This randomized controlled experiment was conducted in the Department of Pediatrics, Children Hospital, Faisalabad, from May 2025 to August 2025, following ethical review committee permission. Patients with fluid-refractory septic shock were included. The patients ranged in this study.  Patients who had undergone cardiopulmonary bypass within the previous five days, those with chronic conditions such as cerebral palsy, congenital heart disease, neuromuscular disorders, metabolic disorders, chronic kidney disease, or those who had previously received peripheral treatment for hypovolemia without a medication history or sequential organ failure at presentation were excluded. A computer-generated random number table was used to randomly split all of the patients into two groups. While Group-B patients got dopamine in incremental dosages of 10–20 μg/kg/minute until the end points of shock resolution were reached, Group A patients received epinephrine (0.1–0.3 μg/k/minute). After 20 minutes of treatment, the resolution of clinical signs and symptoms was evaluated.  Both at baseline and six hours later, the SOFA score was noted.  The effectiveness of the treatment was evaluated in terms of the resolution of clinical signs and symptoms at 20 minutes and the improvement of 4 points in the SOFA score at 6 hours.

Results: The mean age in this study was 5.73 ± 2.38 years, with a range of 1 month to 12 years. Patients in groups A and B had mean ages of 5.84 ± 2.43 and 5.44 ± 2.29 years, respectively. There was a male to female ratio of 1.1:1, with 47 (52.22%) being male and 43 (47.78%) being female.  39 patients (86.67%) responded better to adrenaline than to dopamine when treating fluid-refractory septic shock in children, compared to 26 patients (57.78%).

Conclusion: In children with fluid-refractory cold septic shock, the current study clearly demonstrates that the use of adrenaline is associated with an earlier resolution of shock when compared to dopamine.