TY - JOUR
T1 - Intensity of Vasopressor Therapy and In-Hospital Mortality for Infants and Children
T2 - An Opportunity for Counseling Families
AU - Aziz, Khyzer B.
AU - Boss, Renee D.
AU - Yarborough, Christina C.
AU - Raisanen, Jessica C.
AU - Neubauer, Kathryn
AU - Donohue, Pamela K.
N1 - Publisher Copyright:
© 2020 American Academy of Hospice and Palliative Medicine
PY - 2021/4
Y1 - 2021/4
N2 - Context: Most pediatric deaths occur in an intensive care unit, and treatment specific predictors of mortality could help clinicians and families make informed decisions. Objective: To investigate whether the intensity of vasopressor therapy for pediatric patients, regardless of diagnosis, predicts in-hospital mortality. Methods: Single-center, retrospective medical chart review of children aged 0–17 who were admitted between 2005 and 2015 at a pediatric tertiary care center in the U.S. and received any vasopressor medication—dopamine, dobutamine, epinephrine, vasopressin, norepinephrine, or hydrocortisone. Results: During the 10-year period, 1654 patients received at least one vasopressor medication during a hospitalization. Median age at the time of hospitalization was three months, and the median duration of hospitalization was 23 days; 8% of patients had two to five hospitalizations in which they received vasopressors. There were 176 total patients who died while receiving vasopressors; most (93%) died during their first hospitalization. The most common diagnosis was sepsis (34%), followed by congenital heart disease (17%). Dopamine was the most commonly prescribed first-line vasopressor (70%), and hydrocortisone was the most commonly prescribed second-line vasopressor (49%) for all pediatric patients. The incidence of mortality rose sequentially with escalating vasopressor support, increasing from under 10% with the first vasopressor to 48% at the maximum number of agents. The odds of death almost doubled with the addition of each new vasopressor. Conclusions: The intensity of vasopressor therapy for pediatric patients, regardless of diagnosis, is associated with in-hospital mortality; vasopressor escalation should trigger intensive palliative care supports.
AB - Context: Most pediatric deaths occur in an intensive care unit, and treatment specific predictors of mortality could help clinicians and families make informed decisions. Objective: To investigate whether the intensity of vasopressor therapy for pediatric patients, regardless of diagnosis, predicts in-hospital mortality. Methods: Single-center, retrospective medical chart review of children aged 0–17 who were admitted between 2005 and 2015 at a pediatric tertiary care center in the U.S. and received any vasopressor medication—dopamine, dobutamine, epinephrine, vasopressin, norepinephrine, or hydrocortisone. Results: During the 10-year period, 1654 patients received at least one vasopressor medication during a hospitalization. Median age at the time of hospitalization was three months, and the median duration of hospitalization was 23 days; 8% of patients had two to five hospitalizations in which they received vasopressors. There were 176 total patients who died while receiving vasopressors; most (93%) died during their first hospitalization. The most common diagnosis was sepsis (34%), followed by congenital heart disease (17%). Dopamine was the most commonly prescribed first-line vasopressor (70%), and hydrocortisone was the most commonly prescribed second-line vasopressor (49%) for all pediatric patients. The incidence of mortality rose sequentially with escalating vasopressor support, increasing from under 10% with the first vasopressor to 48% at the maximum number of agents. The odds of death almost doubled with the addition of each new vasopressor. Conclusions: The intensity of vasopressor therapy for pediatric patients, regardless of diagnosis, is associated with in-hospital mortality; vasopressor escalation should trigger intensive palliative care supports.
KW - Vasopressors
KW - decision making
KW - hospital mortality
KW - hydrocortisone
KW - pediatrics
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U2 - 10.1016/j.jpainsymman.2020.09.016
DO - 10.1016/j.jpainsymman.2020.09.016
M3 - Article
C2 - 32942009
AN - SCOPUS:85093667855
SN - 0885-3924
VL - 61
SP - 763
EP - 769
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
IS - 4
ER -