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Vasoactive drug use in children with community acquired septic shock in Australia and New Zealand

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dc.contributor.authorLong, E.
dc.contributor.authorHearps, S.
dc.contributor.authorWilliams, A.
dc.contributor.authorGelbart, B.
dc.contributor.authorButt, W.
dc.contributor.authorRozen, T.
dc.contributor.authorMcNab, S.
dc.contributor.authorBorland, M.L.
dc.contributor.authorErickson, S.
dc.contributor.authorJani, S.
dc.contributor.authorFesta, M.
dc.contributor.authorTan, E.
dc.contributor.authorPhillips, N.
dc.contributor.authorRaman, S.
dc.contributor.authorKochar, A.
dc.contributor.authorGanu, S.
dc.contributor.authorCraig, S.
dc.contributor.authorLithgow, A.
dc.contributor.authorRao, A.
dc.contributor.authorWhyte, E.
dc.contributor.authoret al.
dc.date.issued2026
dc.description.abstractBackground 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
dc.description.statementofresponsibilityElliot Long, Stephen Hearps, Amanda Williams, Ben Gelbart, Warwick Butt, Thomas Rozen, Sarah McNab, Meredith L. Borland, Simon Erickson, Shefali Jani, Marino Festa, Eunicia Tan, Natalie Phillips, Sainath Raman, Amit Kochar, Subodh Ganu, Simon Craig, Anna Lithgow, Arjun Rao, Emma Whyte, Stuart R. Dalziel, Shane George, Fran Balamuth, Scott L. Weiss, Nathan Kuppermann, and Franz E. Babl
dc.identifier.citationThe Lancet Regional Health. Western Pacific, 2026; 66:101777-1-101777-9
dc.identifier.doi10.1016/j.lanwpc.2025.101777
dc.identifier.issn2666-6065
dc.identifier.issn2666-6065
dc.identifier.urihttps://hdl.handle.net/2440/148875
dc.language.isoen
dc.publisherElsevier
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/GNT1190814
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/GNT2034194
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/GNT1127542
dc.rights© 2025 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
dc.source.urihttps://doi.org/10.1016/j.lanwpc.2025.101777
dc.subjectsepsis; child; vasoconstrictor agents; epidemiology; critical care
dc.titleVasoactive drug use in children with community acquired septic shock in Australia and New Zealand
dc.typeJournal article
pubs.publication-statusAccepted

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