ArticleCritical care explorations2023
A Randomized Controlled Trial of Norepinephrine Plus Dobutamine Versus Epinephrine As First-Line Vasoactive Agents in Children With Fluid Refractory Cold Septic Shock.
Article in Critical care explorations, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026.Intensive care medicine · 2026Pooled it
- Prognostic Accuracy of Serially Measured Organ Dysfunction Scores in Children with Fluid Refractory Septic Shock.Indian pediatrics · 2026Article
- Septic Cardiomyopathy: Age-Dependent Physiology and Hemodynamic Aspects-A Narrative Review.Children (Basel, Switzerland) · 2026Review
- Vasoactive drug use in children with community acquired septic shock in Australia and New Zealand.The Lancet regional health. Western Pacific · 2026Article
- Epinephrine vs Norepinephrine as the Initial Vasoactive Agent in Pediatric Septic Shock: A Feasibility Randomized Controlled Trial for Recruitment Rates and Protocol Adherence, the Epinephrine vs Norepinephrine in Pediatric Septic Shock Trial.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2025Article
- Do We Really Need a Perfect Vasoactive Agent for Low-middle Income Countries in Pediatric Septic Shock?Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2025Article
- Use of norepinephrine in the pediatric intensive care unit: an international survey of prescription and administration habits in case of pediatric hypotensive shock.European journal of pediatrics · 2025Article
- The Resuscitation, Equilibrium and De-escalation (RED) strategy: a phased, personalized hemodynamic support in children with sepsis.Frontiers in pediatrics · 2025Review
- An Update on Pharmacologic Management of Neonatal Hypotension: When, Why, and Which Medication.Children (Basel, Switzerland) · 2024Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Our objective was to compare norepinephrine plus dobutamine versus epinephrine as the first-line agent in children with fluid refractory cold septic shock.
designOpen-label randomized controlled study.
settingA single-center PICU from North India. PATIENTS: Children 2 months to less than 18 years old with fluid refractory cold septic shock.
interventionsIn the intervention group, norepinephrine and dobutamine were started and in the control group, epinephrine was started as the first-line vasoactive agent. The primary outcome was the proportion attaining shock resolution (attaining all the therapeutic endpoints) at 1 hour of therapy. MEASUREMENTS AND MAIN
resultsWe enrolled 67 children: 34 in the norepinephrine plus dobutamine group (intervention) and 33 in the epinephrine group (control). There was no difference in shock resolution at 1 hour (17.6% vs 9%; risk ratio [RR], 2.0; 95% CI, 0.54-7.35;
conclusionsIn children with fluid refractory cold septic shock, with use of norepinephrine plus dobutamine as first-line agents, the difference in the proportion of children attaining shock resolution at 1 hour between the groups was inconclusive. However, the time to shock resolution was earlier in the norepinephrine plus dobutamine group. Also, fewer children in the intervention group were refractory to treatment. Further studies powered to detect (or exclude) an important difference would be required to test this intervention.
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Registered trials
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