6/28/23, 12:26 AM Catecholamines in pediatric cold shock Pathway Feedback Search Clinical Topics Home Studies Catecholamines in pediatric cold shock Catecholamines in pediatric cold shock Disease Sepsis and septic shock Trial question Is a combination of norepinephrine and dobutamine superior to epinephrine in children with fluid- refractory cold septic shock? Study design Single center Open label RCT Population Characteristics of study participants 43.0% female N = 67 57.0% male 67 patients (29 female, 38 male) Inclusion criteria: children 2 months to < 18 years old with fluid refractory cold septic shock Key exclusion criteria: fulminant myocarditis; congenital heart disease; severe acute malnutrition; CKD; receipt of vasoactive agents Interventions N=34 norepinephrine plus dobutamine (dose titration of 0.1-0.3 and 10-20 g/kg/min, respectively) N=33 epinephrine (dose titration of 0.1-0.3 g/kg/min) Primary outcome Shock resolution at 1 hour of therapy 17.6 % 17.6 https://web.pathway.md/studies/recmBlbBoRcyExsP5 1/2 6/28/23, 12:26 AM Catecholamines in pediatric cold shock Pathway 13.2 % 9 8.8 % 4.4 % No significant difference 0.0 % Norepinephrine plus dobutamine Epinephrine No significant difference in shock resolution at 1 hour of therapy (17.6% vs. 9%; RR 2, 95% CI 0.54 to 7.35) Secondary outcomes No significant difference in shock resolution at 6 hours of therapy (76.4% vs. 54.5%; RR 1.69, 95% CI 0.92 to 3.13) Significant decrease in time to attain shock resolution (3 hours vs. 6 hours; HR 0.54, 95% CI 0.32 to 0.9) No significant difference in death at day 28 (23.5% vs. 39.3%; RR 0.59, 95% CI 0.28 to 1.25) Safety outcomes No significant difference in adverse events. Conclusion In children 2 months to < 18 years old with fluid refractory cold septic shock, norepinephrine plus dobutamine was not superior to epinephrine with respect to shock resolution at 1 hour of therapy. Reference Kiran Kumar Banothu, Jhuma Sankar, U Vijaya Kumar et al. A Randomized Controlled Trial of Norepinephrine Plus Dobutamine Versus Epinephrine As First-Line Vasoactive Agents in Children With Fluid Refractory Cold Septic Shock. Crit Care Explor. 2022 Dec 28;5(1):e0815. eCollection 2023 Jan. Open reference URL https://web.pathway.md/studies/recmBlbBoRcyExsP5 2/2