Vasoactive drug use in children with community acquired septic shock in Australia and New Zealand

Elliot Long, Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.
Stephen Hearps, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Amanda Williams, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Ben Gelbart, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Warwick Butt, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Thomas Rozen, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Sarah McNab, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Meredith L. Borland, Department of Emergency Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia.
Simon Erickson, Paediatric Intensive Care Unit, Perth Children's Hospital, Nedlands, Western Australia, Australia.
Shefali Jani, Department of Emergency Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Marino Festa, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
Eunicia Tan, Middlemore Hospital, Auckland, New Zealand.
Natalie Phillips, Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.
Sainath Raman, Children's Intensive Care Research Program, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
Amit Kochar, Department of Emergency Medicine, Women and Children's Hospital, Adelaide, South Australia, Australia.
Subodh Ganu, Department of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia.
Simon Craig, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Anna Lithgow, Department of Paediatrics, Royal Darwin Hospital, Tiwi, Northern Territory, Australia.
Arjun Rao, Department of Emergency Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia.
Emma Whyte, Department of Emergency Medicine, Townsville Hospital, Douglas, Queensland, Australia.
Stuart R. Dalziel, Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
Shane George, Children's Intensive Care Research Program, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
Fran Balamuth, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
Scott L. Weiss, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
Nathan Kuppermann, Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Franz E. Babl, Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.

Document Type

Journal Article

Publication Date

1-1-2026

Journal

The Lancet regional health. Western Pacific

Volume

66

DOI

10.1016/j.lanwpc.2025.101777

Keywords

Child; Critical care; Epidemiology; Sepsis; Vasoconstrictor agents

Abstract

BACKGROUND: Vasoactive agents are a critical supportive therapy for children with sepsis. We describe the choice and use patterns of vasoactive agents in children with sepsis. METHODS: Prospective observational study conducted in 11 hospitals in Australia and New Zealand through the Paediatric Research in Emergency Departments International Collaborative (PREDICT) Network from April 2021 to December 2023. Children aged 0-<18 years with suspected sepsis were included. Children admitted to hospital and treated with parenteral antibiotics and either 1) a provisional diagnosis of sepsis, and/or 2) treatment for suspected sepsis (fluid bolus to treat poor perfusion). The frequency and sequence of use of vasoactive agents, and contributors to the choice of initial vasoactive were collected. FINDINGS: 6232 children with suspected sepsis were included; median age of 2.1 years (IQR 0.3-7.1 years), in-hospital mortality of 60 (1.0%), in whom a subset of 306 (4.9%) met Phoenix sepsis criteria. Vasoactive agents were used in 179 (2.9%) children overall and in 144 (45.8%) of those meeting Phoenix sepsis criteria. The most used first, second, and third-line vasoactive agents were adrenaline (90/179; 50.3%), noradrenaline (49/91; 53.8%), and vasopressin (16/40; 40.0%). When comparing noradrenaline vs adrenaline as first line agents, increasing age was associated with preferential use of noradrenaline (RR 1.06, 95% CI 1.03-1.09; p < 0.001). INTERPRETATION: Children with suspected community acquired sepsis rarely received treatment with vasoactive agents. Adrenaline and noradrenaline were the most used agents, though there was substantial variation in their use and sequencing. FUNDING: This study is funded in part by a National Health and Medical Research Council (NHMRC) Medical Research Future Fund grant (GNT1190814). The full list of funders is presented at the end of the paper.

Department

Pediatrics

Link to Full Text

Share

COinS