Document Type
Article
Publication Date
12-15-2025
Abstract
BACKGROUND: Vasoactive agents are a critical supportive therapy for children with sepsis. We describe the choice and use patterns of vasoactive agents in children with sepsis.
METHODS: Prospective observational study conducted in 11 hospitals in Australia and New Zealand through the Paediatric Research in Emergency Departments International Collaborative (PREDICT) Network from April 2021 to December 2023. Children aged 0-< 18 years with suspected sepsis were included. Children admitted to hospital and treated with parenteral antibiotics and either 1) a provisional diagnosis of sepsis, and/or 2) treatment for suspected sepsis (fluid bolus to treat poor perfusion). The frequency and sequence of use of vasoactive agents, and contributors to the choice of initial vasoactive were collected.
FINDINGS: 6232 children with suspected sepsis were included; median age of 2.1 years (IQR 0.3-7.1 years), in-hospital mortality of 60 (1.0%), in whom a subset of 306 (4.9%) met Phoenix sepsis criteria. Vasoactive agents were used in 179 (2.9%) children overall and in 144 (45.8%) of those meeting Phoenix sepsis criteria. The most used first, second, and third-line vasoactive agents were adrenaline (90/179; 50.3%), noradrenaline (49/91; 53.8%), and vasopressin (16/40; 40.0%). When comparing noradrenaline vs adrenaline as first line agents, increasing age was associated with preferential use of noradrenaline (RR 1.06, 95% CI 1.03-1.09; p < 0.001).
INTERPRETATION: Children with suspected community acquired sepsis rarely received treatment with vasoactive agents. Adrenaline and noradrenaline were the most used agents, though there was substantial variation in their use and sequencing.
FUNDING: This study is funded in part by a National Health and Medical Research Council (NHMRC) Medical Research Future Fund grant (GNT1190814). The full list of funders is presented at the end of the paper.
Recommended Citation
Long, Elliot; Hearps, Stephen; Williams, Amanda; Gelbart, Ben; Butt, Warwick; Rozen, Thomas; McNab, Sarah; Borland, Meredith; Erickson, Simon; Jani, Shefali; Festa, Marino; Tan, Eunicia; Phillips, Natalie; Raman, Sainath; Kochar, Amit; Ganu, Subodh; Craig, Simon; Lithgow, Anna; Rao, Arjun; Whyte, Emma; Dalziel, Stuart; George, Shane; Balamuth, Fran; Weiss, Scott; Kuppermann, Nathan; and Babl, Franz, "Vasoactive Drug Use in Children With Community Acquired Septic Shock in Australia and New Zealand" (2025). Department of Medicine Faculty Papers. Paper 537.
https://jdc.jefferson.edu/medfp/537
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
PubMed ID
41497389
Language
English
Included in
Chemical Actions and Uses Commons, Critical Care Commons, Pathological Conditions, Signs and Symptoms Commons, Therapeutics Commons
Comments
This article is the author’s final published version in The Lancet Regional Health - Western Pacific, Volume 66, 2026, Article number 101777.
The published version is available at https://doi.org/10.1016/j.lanwpc.2025.101777. Copyright © 2025 The Author(s).