requirements. Generally an intravenous bolus is given with a subsequent
continuous infusion that ranges from 0.1-0.4 μg/kg/minute.
Receptor Effects of Commonly Used Vasoactive Agents
Agent D 1 D 2 Alpha 1 ß 1 ß 2 V 1
Dopamine 0.5- 10 0.5- 10 >10 3 - 10
Norepinephrine +++
Epinephrine 0.1-1.0+ 0.05-0.1 0.05-0.1
Isoproterenol +++
Phenylephrine +++
Dobutamine ++ +
Vasopressin ++
Dose ranges are presented in ug/kg/minute.
VI. ECMO
(^) ECMO has been used in the neonatal and pediatric patients to treat pump
failure or cardiogenic shock. This is most commonly seen in the post-operative
setting. However, ECMO has also been used in patients with refractory septic
shock. Some studies indicate that ECMO using central access has better results
in this setting [8.9].
References:
- hemodynamic monitor in critical illness. [Review]Ghanayem NS. Wernovsky G. Hoffman GM. Near. Pediatric Critical Care -infrared spectroscopy as a
Medicine. 12(4 Suppl):S27-32, 2011 Jul - Rivers E, Nguyen B, Havstad S, et al. Early Goal-Directed Therapy
Collaborative Group. Early goal-directed therapy in the treatment of severe
sepsis and septic shock. N Engl J Med. 2001 Nov 8;345(19):1368-77. - de Oliveira CF, de Oliveira DS, Gottschald AF, et al. ACCM/PALS
haemodynamic support guidelines for paediatric septic shock: an outcomes
comparison with and without monitoring central venous oxygen saturation.