title: Norepinephrine infusion increases urine output in children under sedative and analgesic infusion.
abstract: OBJECTIVE
  To evaluate the effects of early norepinephrine (NE) infusion in children submitted to mechanical ventilation (MV) requiring continuous sedative and analgesic infusion.
  
  
  METHODS
  Double-blinded, randomized, placebo-controlled trial enrolling children (1 month to 12 years of age) admitted to a Brazilian PICU and expected to require MV and continuous sedative and analgesic drug infusions for at least five days. Children were randomized to receive either norepinephrine (NE) (0.15 mcg/kg/min) or normal saline infusion, started in the first 24 hours of MV, and maintained for 72 hours. We compared hemodynamic variables, fluid intake, renal function and urine output between groups.
  
  
  RESULTS
  Forty children were equally allocated to the NE or placebo groups, with no differences in baseline characteristics, laboratorial findings, PRISM II score, length of MV, or mortality between groups. The average norepinephrine infusion was 0.143 mcg/kg/min. The NE group showed higher urine output (p = 0.016) and continuous increment in the mean arterial pressure compared to the baseline (p = 0.043). There were no differences in the remaining hemodynamic variables, fluid requirements, or furosemide administration.
  
  
  CONCLUSIONS
  Early norepinephrine infusion in children submitted to MV improves mean arterial pressure and increases urine output. These effects were attributed to reversion of vasoplegia induced by the sedative and analgesic drugs.
authors.affiliation: Pediatric Emergency and Intensive Care Department, Hospital de Clínicas de Porto Alegre, UFRGS University, Porto Alegre, RS, Brazil.
authors.forename: Jefferson
authors.initials: J
authors.lastname: Piva
authors.affiliation: Intensive Care Unit, H. São lucas, PUCRS University, Porto alegre, RS, Brazil.
authors.forename: Tamila
authors.initials: T
authors.lastname: Alquati
authors.affiliation: Intensive Care Unit, H. São lucas, PUCRS University, Porto alegre, RS, Brazil.
authors.forename: Pedro Celiny
authors.initials: PC
authors.lastname: Garcia
authors.affiliation: Intensive Care Unit, H. São lucas, PUCRS University, Porto alegre, RS, Brazil.
authors.forename: Humberto
authors.initials: H
authors.lastname: Fiori
authors.affiliation: Intensive Care Unit, H. São lucas, PUCRS University, Porto alegre, RS, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Einloft
authors.affiliation: Intensive Care Unit, H. São lucas, PUCRS University, Porto alegre, RS, Brazil.
authors.forename: Francisco
authors.initials: F
authors.lastname: Bruno
mesh_terms: D000700:Analgesics / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects*; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D004231:Diuresis / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D007223:Infant; D007260:Infusion Pumps; D015278:Intensive Care Units, Pediatric; D008297:Male; D009638:Norepinephrine / Q000008:administration & dosage* / Q000494:pharmacology; D010865:Pilot Projects; D012121:Respiration, Artificial; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000494:pharmacology
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives; D014662:Vasoconstrictor Agents; D009638:Norepinephrine