DOI: 10.4103/aam.aam_600_26 ISSN: 1596-3519

Clinical Profile and Outcomes of Inotropes Use in a Pediatric Intensive Care Unit: A Prospective Observational Study

Sadhu Pooja, Sampada Tambolkar, Devika Jadhav, Manojkumar Patil
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Abstract

Background:

The management of hemodynamic instability in critically ill pediatric patients represents one of the most challenging aspects of intensive care medicine. The appropriate selection, timing, and titration of fluid therapy, inotropic and vasoactive agents can significantly impact patient outcomes, making the development and implementation of standardized protocols an essential aspect of quality care.

Materials and Methods:

This prospective observational study was carried out in the pediatric intensive care unit (PICU) among children aged 1 month to 14 years admitted to the PICU and requiring inotropic agents, after approval from the institutional scientific and ethics committee. A comprehensive evaluation of each enrolled patient was done and documented in a standardized case record form. Demographic and clinical details, including history, comorbidities, examination findings, diagnosis, type of shock, and laboratory parameters were noted. Details of inotropic agents used in each individual patient were documented. Response to therapy and outcome measures such as duration of inotropic support, need for escalation to multiple agents, time to achieve hemodynamic stability, success of weaning attempts, length of PICU stay, mechanical ventilation requirements, mortality, presence of multiorgan dysfunction, and use of steroids were noted and analyzed statistically.

Results:

A total of 100 children (aged 1 month to 14 years) admitted to the PICU and requiring inotropic support were enrolled. Infants (<1 year) (35%) constituted the largest proportion of the study population, followed by children aged 1–5 years (33%). Respiratory symptoms with fever were the most common presenting complaints (28%), followed by gastrointestinal manifestations (24%). Comorbidities were present in 38% of patients, with cardiac conditions being the most prevalent. Hypovolemic shock was the most common type observed (44%), followed by septic shock (41%) and cardiogenic shock (18%). Fluid resuscitation practices in this study were consistent with international recommendations, with most patients receiving one or two boluses. Adrenaline was the most commonly used first-line inotrope (63%), although noradrenaline was preferentially used in septic shock and adrenaline in cardiogenic shock. More than half of the patients (56%) required escalation to a second inotrope. The use of complex combination therapy was significantly associated with mortality ( P < 0.001); among nonsurvivors, 62.5% received combination therapy, compared with only 19.1% of survivors. In septic shock, early initiation and timely escalation of inotropic therapy were associated with improved hemodynamic stabilization. Mechanical ventilation was required in 59% of patients, and multiorgan dysfunction syndrome (MODS) was observed in 21%. The duration of PICU stay was influenced by the number of inotropes required, with prolonged stays associated with higher inotropic support. De-escalation of inotropic support was guided by clinical improvement and hemodynamic stability. Steroids were used selectively in 22% of patients. The overall mortality rate was 32%. Key predictors of adverse outcomes identified in this study included the requirement for multiple inotropes, the need for mechanical ventilation, and the presence of MODS.

Conclusions:

Protocol-based management of pediatric shock has been shown to improve outcomes. The findings of this study reinforce the importance of early recognition, timely intervention, and individualized, protocol-driven management in improving outcomes in pediatric shock.

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