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Norepinephrine infusion increases urine output in children under sedative and analgesic infusion / Infusão de noradrenalina aumenta o débito urinário de crianças recebendo drogas sedoanalgésicas
Piva, Jefferson; Alquati, Tamila; Garcia, Pedro Celiny; Fiori, Humberto; Einloft, Paulo; Bruno, Francisco.
  • Piva, Jefferson; UFRGS University. Hospital de Clínicas de Porto Alegre. Pediatric Emergency and Intensive Care Department. Porto Alegre. BR
  • Alquati, Tamila; UFRGS University. Hospital de Clínicas de Porto Alegre. Pediatric Emergency and Intensive Care Department. Porto Alegre. BR
  • Garcia, Pedro Celiny; UFRGS University. Hospital de Clínicas de Porto Alegre. Pediatric Emergency and Intensive Care Department. Porto Alegre. BR
  • Fiori, Humberto; UFRGS University. Hospital de Clínicas de Porto Alegre. Pediatric Emergency and Intensive Care Department. Porto Alegre. BR
  • Einloft, Paulo; UFRGS University. Hospital de Clínicas de Porto Alegre. Pediatric Emergency and Intensive Care Department. Porto Alegre. BR
  • Bruno, Francisco; UFRGS University. Hospital de Clínicas de Porto Alegre. Pediatric Emergency and Intensive Care Department. Porto Alegre. BR
Rev. Assoc. Med. Bras. (1992) ; 60(3): 208-215, May-Jun/2014. tab, graf
Article in English | LILACS | ID: lil-713065
ABSTRACT

Objective:

to evaluate the effects of early norepinephrine (NE) infusion in children submitted to mechanical ventilation (MV) requiring continuous sedative and analgesic infusion.

Methods:

double-blinded, randomized, placebo-controlled trial enrolling children (1 month to 12 years of age) admitted to a Brazilian PICU and expected to require MV and continuous sedative and analgesic drug infusions for at least five days. Children were randomized to receive either norepinephrine (NE) (0.15 mcg/kg/min) or normal saline infusion, started in the first 24 hours of MV, and maintained for 72 hours. We compared hemodynamic variables, fluid intake, renal function and urine output between groups.

Results:

forty children were equally allocated to the NE or placebo groups, with no differences in baseline characteristics, laboratorial findings, PRISM II score, length of MV, or mortality between groups. The average norepinephrine infusion was 0.143 mcg/kg/min. The NE group showed higher urine output (p = 0.016) and continuous increment in the mean arterial pressure compared to the baseline (p = 0.043). There were no differences in the remaining hemodynamic variables, fluid requirements, or furosemide administration.

Conclusion:

early norepinephrine infusion in children submitted to MV improves mean arterial pressure and increases urine output. These effects were attributed to reversion of vasoplegia induced by the sedative and analgesic drugs. .
RESUMO

Objetivo:

avaliar os efeitos da infusão de noradrenalina (NA) em crianças submetidas a ventilação mecânica (VM) requerendo infusão contínua de sedoanalgesia.

Métodos:

estudo duplo cego, randomizado e placebo controlado envolvendo crianças de 1 mês a 12 anos, admitidas em uma UTI pediátrica brasileira com a expectativa de necessidade de VM e sedoanalgesia por, no mínimo, 5 dias. As crianças foram randomizadas a receber infusão de NA (0,15 mcg/kg/min) ou solução salina, iniciadas nas primeiras 24 horas de VM e mantidas por 72 horas. Comparamos as variáveis hemodinâmicas, oferta hídrica, função renal e débito urinário entre os dois grupos.

Resultados:

40 crianças foram alocadas aos grupos NA e placebo, sem diferenças nas características basais, achados laboratoriais, escore PRISM II, tempo de VM ou mortalidade. A infusão média de NA foi 0,143 mcg/kg/min. O grupo NA apresentou maior débito urinário (p = 0,016) e aumento constante da pressão arterial média quando comparado aos níveis basais (p = 0,043). Não se observou diferenças nas demais variáveis hemodinâmicas, reposição hídrica ou no uso de furosemida.

Conclusão:

infusão precoce de NA em crianças submetidas a VM em uso sedoanalgesia promove aumento na pressão arterial média e aumento da diurese. Esses efeitos são atribuídos à reversão da vasoplegia induzida pelas drogas sedativas e analgésicas. .
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Vasoconstrictor Agents / Blood Pressure / Norepinephrine / Diuresis Type of study: Controlled clinical trial Limits: Child / Child, preschool / Female / Humans / Infant / Male Country/Region as subject: South America / Brazil Language: English Journal: Rev. Assoc. Med. Bras. (1992) Year: 2014 Type: Article Affiliation country: Brazil Institution/Affiliation country: UFRGS University/BR

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Full text: Available Index: LILACS (Americas) Main subject: Vasoconstrictor Agents / Blood Pressure / Norepinephrine / Diuresis Type of study: Controlled clinical trial Limits: Child / Child, preschool / Female / Humans / Infant / Male Country/Region as subject: South America / Brazil Language: English Journal: Rev. Assoc. Med. Bras. (1992) Year: 2014 Type: Article Affiliation country: Brazil Institution/Affiliation country: UFRGS University/BR