PedsCrit
Septic Shock with Dr. Scott Weiss Part 2
Apr 10, 2023
Dr. Scott Weiss, an Associate Professor of Pediatrics and Pathology, discusses the use of vasoactive agents and monitoring of hemoglobin and lactate values in the treatment of septic shock. He explores the choice of vasoactive agents for children with septic shock and highlights the differences between pediatric and adult practice. He emphasizes the importance of reassessing non-responsive septic shock patients, identifying common dynamics of sepsis, and improving the management of children with septic shock.
34:05
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Quick takeaways
- Epinephrine is now recommended as the first-line choice over dopamine for children with septic shock due to its potency and lack of adverse effects associated with dopamine.
- Adding a second vasoactive agent should be considered when the initial agent is not effectively managing shock, and this decision depends on individual patient factors and clinical judgment.
Deep dives
Choice of Vasoactive Agent for Septic Shock
For children with septic shock, dopamine was historically the preferred first-line vasoactive agent due to its availability. However, recent studies have shown that epinephrine has a mortality benefit over dopamine as an initial vasoactive agent. Epinephrine is now recommended as the first-line choice due to its potency and lack of adverse effects associated with dopamine. There is no clear evidence comparing epinephrine with norepinephrine, but both are considered reasonable options. The decision between the two can be informed by additional assessments like point-of-care cardiac ultrasound.
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