Inotropic and Vasoactive Drugs in Pediatric ICU

Marco      Piastra; Ersilia      Luca; Sonia      Mensi; Federico      Visconti; Daniele      De Luca; Francesca      Vitale; Domenico      Pietrini

Abstract

Circulatory failure recognition and treatment represents an important issue in critically ill infants and children. Early diagnosis and prompt institution of adequate treatment may be life-saving for pediatric patients with cardiocirculatory instability in the setting of intensive care. However, the hemodynamic status of the critically ill child is poorly reflected by baseline vital parameters or laboratory blood tests. A reliable tool for diagnosis and monitoring of evolution of both heart performance and vascular status is strictly needed. Advanced hemodynamic monitoring consists – among others - of measuring cardiac output, predicting fluid responsiveness and calculating systemic oxygen delivery. Identification and quantifying of pulmonary edema has also been recently appreciated in pediatric critical care. In the last decade, the number of vasoactive drugs has increased, together with a better understanding of clinical application of both different monitoring devices and treatment strategies.

Keywords: Haemodynamic monitoring, heart failure, inotropes, pediatric shock, PICU, vasoactive drugs, pediatric patients, pulmonary edema, cardiac output, blood pressure