title: Noradrenaline use for septic shock in children: doses, routes of administration and complications.
abstract: OBJECTIVE
  To report our 10 year experience with noradrenaline use in children with septic shock focusing on doses, routes of administration and complications.
  
  
  METHODS
  Retrospective single-centre review of children with septic shock who received noradrenaline between 2000 and 2010.
  
  
  RESULTS
  We identified 144 children with septic shock treated with noradrenaline, in 22% as the first-line drug. The median volume resuscitation before vasoactive agent administration was 50 mL/kg interquartile range [IQR: 30-70]. Mean doses of noradrenaline ranged from 0.5 ± 0.4 μg/kg per min (starting dose) to 2.5 ± 2.2 μg/kg per min (maximum dose). Noradrenaline was administered via peripheral venous access or intra-osseous route in 19% of cases for a median duration of 3 h [IQR: 2-4] without any adverse effects. The use of noradrenaline increased over the study period. Mortality rate was 45% with a significant decrease over the study period. Adverse effects included arrhythmia in two children and hypertension in eight children. None of these arrhythmias required treatment and hypertension resolved with the noradrenaline dose reduction.
  
  
  CONCLUSIONS
  Higher doses of noradrenaline than those suggested in the literature may be necessary to reverse hypotension and hypoperfusion. The use of noradrenaline through peripheral venous access or intra-osseous route was safe, without any adverse effects.
authors.affiliation: PICU, University hospital of Lille, France.
authors.forename: M E
authors.initials: ME
authors.lastname: Lampin
authors.forename: J
authors.initials: J
authors.lastname: Rousseaux
authors.forename: A
authors.initials: A
authors.lastname: Botte
authors.forename: A
authors.initials: A
authors.lastname: Sadik
authors.forename: R
authors.initials: R
authors.lastname: Cremer
authors.forename: F
authors.initials: F
authors.lastname: Leclerc
mesh_terms: D016470:Bacteremia / Q000150:complications; D002648:Child; D002675:Child, Preschool; D004280:Dobutamine / Q000008:administration & dosage; D004298:Dopamine / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications; D006801:Humans; D007223:Infant; D008297:Male; D009638:Norepinephrine / Q000008:administration & dosage* / Q000009:adverse effects*; D012141:Respiratory Tract Infections / Q000150:complications; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000209:etiology; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects*
chemical_list: D014662:Vasoconstrictor Agents; D004280:Dobutamine; D004298:Dopamine; D009638:Norepinephrine