Which Pressor Works Best for Pediatric Septic Shock?

TOPLINE:

In children with septic shock without known cardiac dysfunction, initial treatment with norepinephrine was associated with a lower 30-day mortality but similar rates of major adverse kidney events by 30 days (MAKE30) compared with epinephrine, a study reported.

METHODOLOGY:

• Researchers conducted a single-center, retrospective cohort study of 231 patient encounters (median age, 11.4 years; 54.6% girls) requiring a vasoactive infusion within 24 hours of emergency department arrival between June 2017 and December 2023.
• The primary outcome was MAKE30, a composite outcome of death, new kidney replacement therapy, or persistent kidney dysfunction by 30 days or hospital discharge.
• Participants received either epinephrine (63.6%) or norepinephrine (36.4%) as the first vasoactive medication.

TAKEAWAY:

• After propensity score matching, 30-day mortality was higher in patients who received epinephrine than in those who received norepinephrine (3.7% vs 0%; risk difference, 3.7%).
• Patients initially treated with epinephrine required additional vasoactive medications more often than those initially treated with norepinephrine (47.6% vs 17.9%), with norepinephrine being the most common second agent in the epinephrine group.
• No significant differences in MAKE30 were observed between the treatment groups after inverse probability of treatment weighting.
• Similarly, no significant differences were found between the two groups in kidney replacement therapy, intensive care unit–free days, or hospital-free days.

IN PRACTICE:

“These findings suggest that children without known cardiac dysfunction who received norepinephrine as the initial vasoactive agent for septic shock had lower mortality but similar rates of MAKE30 compared with children receiving epinephrine,” the authors wrote.

SOURCE:

The study was led by Matthew A. Eisenberg, MD, MPH, Division of Emergency Medicine, Boston Children’s Hospital, Boston. It was published online on April 11, 2025, in JAMA Network Open.

LIMITATIONS:

The study was limited by its single-center design, unmeasured confounding, and an inadequate sample size to detect rare outcomes or assess differences within specific patient subgroups.

DISCLOSURES:

The authors did not disclose any funding information. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.