Management and Outcome of Paediatric Septic Shock Requiring Vasoactive Therapy: A Multicentre Prospective Observational Study

AIM: Although vasoactive drugs are recommended for paediatric septic shock requiring vasoactive therapy (PSSRVT), evidence on optimal agent selection remains limited. This study aimed to describe clinical characteristics, vasoactive drug use, adjunctive treatments, and outcomes of patients with PSSRVT. METHODS: This multicentre, prospective study was conducted between 1 October 2024 and 30 April 2025, across 16 Paediatric Intensive Care Units (PICUs). RESULTS: The study included 225 PSSRVT patients treated with vasoactive agents, with a PICU frequency of 5%. Normal saline was administered in 93% of cases (mean 29.6 ± 14.0 mL/kg). A single vasoactive drug was used in 23% of patients, while 45% received two. Epinephrine was the most common first-line drug (70%), followed by norepinephrine (27%). Corticosteroids were used in 53% of vasopressor-resistant cases, with a median vasoactive inotrope score (VIS) of 60 (40-100). Among patients requiring intubation due to escalating sepsis severity, the median (IQR) VIS at the time of intubation was 50 (30-70). Overall mortality was 59%. CONCLUSION: Multiple vasoactive drugs were required in most patients, with usage patterns differing from previous reports. The median VIS at corticosteroid initiation was close to the VIS threshold associated with increased mortality. Further studies are needed to optimize vasoactive agent selection and sequencing.