The Efficacy of Epinephrine versus Norepinephrine on the Outcome of Children with Septic Shock

Background: Severe sepsis and septic shock remain significant causes of death and morbidity in critically-ill kids, with the majority of deaths occurring in settings lacking intensive care facilities. Pediatric septic shock is described as sepsis with cardiovascular dysfunction, which may occur without hypotension, in contrast to adult definitions. Optimal vasoactive therapy in pediatric septic shock remains debated, with limited evidence comparing epinephrine and norepinephrine. Aim of the study: This prospective observational research aimed to compare the clinical outcomes of epinephrine versus norepinephrine in pediatric septic shock. Methodology: A total of 68 kids admitted to the Pediatric Intensive Care Unit (PICU) at Menoufia University Hospital and Shebin El Koum Teaching Hospital with septic shock were enrolled and separated into two groups depending on the vasoactive agent administered. Group A: 34 kids with septic shock who will receive adrenaline. Group B: 34 kids with septic shock who will receive noradrenaline.
Results: Demographic and baseline hemodynamic parameters were comparable between groups. Norepinephrine recipients required significantly higher drug doses (7.79 ± 1.64 vs. 0.20 ± 0.05 μg/kg/min, p < 0.001) and greater fluid resuscitation volumes (51.73 ± 5.66 vs. 40.00 mL/kg, p < 0.001) than those receiving epinephrine. The norepinephrine group also demonstrated a higher need for mechanical ventilation (97.1% vs. 58.8%, p < 0.001) and longer ventilation duration (6.50 ± 2.78 vs. 3.41 ± 3.58 days, p < 0.001). PICU length of stay was significantly shorter in the epinephrine group (3.65 ± 3.78 vs. 6.97 ± 2.85 days, p < 0.001). Although survival differences were not statistically significant, epinephrine was related to a higher survival rate (97.1% vs. 85.3%). The norepinephrine group had a significantly higher need for mechanical ventilation and a longer duration of ventilation than the epinephrine group (p < 0.001). PRISM and PRISM III scores were significantly lower in the epinephrine group, indicating reduced illness severity. Mortality predictors included lower mean blood pressure, prolonged capillary refill time, elevated CRP and creatinine, metabolic acidosis, hyperkalemia, higher vasoactive requirements, and greater fluid volumes.
Conclusion: Findings showed that epinephrine was associated with improved clinical outcomes in pediatric septic shock, particularly regarding ventilation needs and PICU stay. Larger multicenter trials are warranted to confirm these results and guide practice.