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First-line Vasopressor in Septic Shock Dopamine vs Epinephrine Dr. Lâm Trung Hiếu PICU

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Page 1: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

First-line Vasopressorin Septic Shock

Dopamine vs Epinephrine

Dr. Lâm Trung Hiếu

PICU

Page 2: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

Contents

Reviews

Guidelines

Dopamine vs Epinephrine

Conclusions

Page 3: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

Reviews

Septic shock : Sepsis plus cardiovascular organ dysfunction

Mortality: 20-60%*

*WHO-2009

Page 4: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

*2007 the American College of Critical Care Medicine

Page 5: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

Which Vasopressor is the 1st- choice?

Page 6: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

Page 7: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

Page 8: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

Page 9: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

Page 10: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

Dopamine Vs Epinephrine

Page 11: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

Page 12: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

Dopamine vs Epinephrine

• Design: prospective RCT, 01/02/2009 - 31/07/2013

• Setting: PICU, Universidade de São Paulo, Brazil

• Patients: children 1m-15y fluid-refractory septic shock

• Interventions:

Dopamine (5-10) - Epinephrine (0.1-0.3 μg/kg/min)

• Outcomes: 28-day mortality

Healthcare-associated infections

Dopamin vs Epinephrine

Page 17: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

Page 18: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

Page 19: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

Page 20: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

Conclusions

Page 21: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

Conclusions

1st-choice Vasopressor in Septic shock:

Epinephrine > Dopamine

(Survival and Healthcare-associated infection)

Page 22: Vasoactive Drugs in Septic Shock Dopamin vs Epinephrine · First-Line Vasoactive Drugs in Pediatric Septic Shock. Ventura AMI, Shieh HH, Bousso A, Góes PF, Fernandes Ide C, de Souza

Thank for Yours Attention!

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