(1684) Use of Vasoactive Medications Across Pediatric Intensive Care Units

Introduction: Multiple medications are available to support the hemodynamics of critically ill children. While medication choice is driven by patient physiology, other factors, including institutional practice and policies may influence prescribing patterns. Our objective was to describe vasoactive use across a multicenter collaborative.

Methods: We queried PICU Data Collaborative (PDC), a multicenter repository of pediatric critical care data, for vasoactive infusions comprising the Vasoactive Inotropic Score (VIS) from 1/1/2010 to 12/31/2022. The VIS is a weighted average of epinephrine, norepinephrine, vasopressin, dopamine, dobutamine, and milrinone. We obtained hourly medication data for the first 7 days of each intensive care unit (ICU) encounter and calculated VIS values. ChatGPT 3.0 and 40 mini were used to assistance with writing code in Python.

Results: Of 135,719 encounters from six sites in the PDC with medication and admissions data, 18,630 (14%) received at least one vasoactive infusion. At 12 hours after admission, 7999 (6%) were on a single vasoactive, with 2272 (2%) on >1. Among encounters with vasoactives at any point, the most commonly used medication was epinephrine (54%), followed by norepinephrine (53%), milrinone (52%), dopamine (18%), and vasopressin (13%). Of the 6 sites, 4 had a dedicated cardiac ICU where the most commonly used vasoactives were milrinone (83%), norepinephrine (63%), and epinephrine (56%). The most common combinations 12 hours after admission were milrinone/dopamine (798, 10% of those on vasoactives at that time) and milrinone/dopamine/epinephrine (405, 5%). Median duration of use was 23 hours (8-60); median peak VIS was 9 (5-14). Mortality among encounters receiving vasoactive medications was 7.5%.

Conclusions: Vasoactive medication use differed across a heterogenous population of critically ill children, likely reflecting variability in physiology and practice patterns. One in four encounters in the sample remained on vasoactives for more than 2.5 days. Mortality was approximately twice the reported general pediatric ICU mortality.