(1685) Vasoactive Inotropic Score Following Administration of Hydrocortisone or Methylene Blue in Children

Introduction: Patients with refractory shock may receive adjunctive interventions to improve their hemodynamic profile. We hypothesized that administration of hydrocortisone or methylene blue would be associated with decreased VIS over time.

Methods: We queried the PICU Data Collaborative (PDC), a multicenter repository of pediatric critical care data, for medications comprising the Vasoactive Inotropic Score (VIS). We included encounters if within the first 7 days of intensive care unit (ICU) admission: 1) a vasoactive infusion was administered, and 2) hydrocortisone (HC) and/or methylene blue (MB) was administered. We calculated the change in VIS from the hour prior to the hour after first HC and/or MB administration. Data are presented as number (%) and median [interquartile range] unless otherwise noted. We compared pre-post administration VIS using Wilcoxon signed rank test. ChatGPT 3.0 and 40 mini used to assistance with writing code in Python.

Results: Of 92,158 ICU encounters from four sites in the PDC with the necessary medication and admissions data, 16,009 (17%) received at least one vasoactive infusion. Of these, HC was administered in 3333 (21%) encounters and MB was administered in 17 (0.1%). Median VIS in the hour before HC was 3 [0-10] and MB 4 [0-8]. There was a statistically significant change (increase) in VIS from the hour before (median 3 [0-10]) to the hour after HC (median 3 [0-10], p < 0.001). There was no change in VIS from the hour before to 4 hours after HC administration (median 2 [0-10], p=0.71) or from the hour before (median 4 [0-8]) to the hour after MB administration (median 6 [4-30], p=0.57). The proportion of encounters at a given site in which HC was administered ranged from 11% to 22%. Encounter-level mortality was 17% in those who received HC and 24% in those who received MB.

Conclusions: Adjunctive therapies intended to increase hemodynamic stability were used frequently across heterogeneous population of critically ill children. Although there was a statistically significant change in VIS in the hour after HC administration, the absolute change was small. This change in VIS did not persist at 4 hours after HC administration. Administration of MB was rare and was not associated with a change in VIS.