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Abstract Body

The question is: do vasoactive drugs save my patients?

The answer is not that clear. In the following presentation we discuss this question in four scenarios: fluid-resistant septic shock, postoperative period after open heart surgery, acute heart failure, and the use of vasopressors outside PICU.

Last published guidelines recommend using epinephrine or norepinephrine rather than dopamine, although the panelists were unable to issue a recommendation for a specific first-line vasoactive infusion.

Advanced monitoring is useful to identify where is the problem and how to tackle it. The presentation of the septic shock is variable, and the hemodynamic situation can change during the first hours.

A low cardiac output state (LCOS) complicates the postoperative course of 25% of infants and children early after cardiopulmonary bypass (CPB). Milrinone seems to improve this situation and is the only drug that has not been independently associated with an increase in mortality, after adjusting for risk factors, following CPB.

Pharmacological support of the failing paediatric heart remains a challenging task. The special physiologic features of the paediatric heart do not allow to extrapolate the adult results. The first goal is to restore cardiac output and end-organ perfusion. The second goals are cardiac restoration and regeneration, and to avoid cardiotoxicity of ß1 receptor chronic stimulation: apoptosis, necrosis and desensitization.

According to retrospective pediatric studies, it is safe to start the infusion through peripheral venous access, including neonates, vasopressors or combination of several drugs. The risk of infiltration rises with increasing medication dose and duration of use.