Low-Dose Epinephrine Boluses for Acute Hypotension in the PICU

Objectives: To describe the use of low-dose bolus epinephrine in critically ill children during an acute hypotensive episode or prearrest condition. Design: Institutional Review Board approved, single-center, retrospective medical chart review. Setting: Large medical-surgical PICU within a freestanding, tertiary care children’s hospital. Patients: Patients admitted to the PICU between June 1, 2015, and June 1, 2016, who received low-dose (≤ 5 µg/kg) IV bolus epinephrine. Interventions: None. Measurement and Main Results: Twenty-four resuscitation episodes (63 doses; 19 patients) were analyzed. Median age and weight of patients were 9 years (interquartile range, 1–15 yr) and 38.5 kg (interquartile range, 12–54.8 kg). Median Pediatric Risk of Mortality III score was 17 (interquartile range, 10–27). Mean epinephrine dose was 1.3 ± 1.1 µg/kg. Median number of doses per patient was two. If more than one dose was provided, median dosing interval was 6.5 minutes. Heart rate and mean arterial blood pressure were compared at the time of epinephrine administration and 1–4 minutes (median = 1 min) following administration. Heart rate changed from 130 ± 41 to 150 ± 33 beats/min (p

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