PEM PEARL: Epi vs Norepi
Is there a difference in outcomes in epi vs norepi as the first vasoactive agent administered in septic shock?
Here is a retrospective cohort study from Boston Children's that assessed this question. They reviewed 231 encounters and used propensity matching to compare the groups (groups were lopsided with 2:1 favoring the use of epi first). There was no difference in primary outcome (major adverse kidney events by 30 days (MAKE30)). However there was a statistical significance in 30-day mortality between the groups. There were 6 deaths of the 147 patients in the epi group, while there were no deaths in the 84 patients in the norepi group, showing an absolute risk difference of 3.7%.
Bottom line: while this was a smaller, retrospective review, there was a statistically significant difference seen in the use of norepinphrine as the first line agent in children with septic shock. This matches adult guidelines as their recommended first-line pressor in sepsis is also norepinphrine. Hopefully this leads to larger prospective studies, but something to consider in the meantime!
Here is a retrospective cohort study from Boston Children's that assessed this question. They reviewed 231 encounters and used propensity matching to compare the groups (groups were lopsided with 2:1 favoring the use of epi first). There was no difference in primary outcome (major adverse kidney events by 30 days (MAKE30)). However there was a statistical significance in 30-day mortality between the groups. There were 6 deaths of the 147 patients in the epi group, while there were no deaths in the 84 patients in the norepi group, showing an absolute risk difference of 3.7%.
Bottom line: while this was a smaller, retrospective review, there was a statistically significant difference seen in the use of norepinphrine as the first line agent in children with septic shock. This matches adult guidelines as their recommended first-line pressor in sepsis is also norepinphrine. Hopefully this leads to larger prospective studies, but something to consider in the meantime!
