Our team recently reviewed 144 historical patients who received epinephrine for very low blood pressure in a Boston Children's Hospital intensive care unit. We found information that helped us to design the EPI Dose Study as safely as possible:
- Most commonly, doctors gave a first dose of 0.7 mcg/kg, and the average increase in systolic blood pressure of 31 mmHg (good response).
- Doctors used a wide variety of initial doses of epinephrine, most of which were between 0.3 and 2 mcg/kg.
- We were not able to find an association between the dose and the effect on blood pressure (for example, higher doses did not necessarily result in bigger raises in blood pressure).
- We also found that for a subset of patients, the first dose of epinephrine did not significantly raise their blood pressure, and they needed either more epinephrine or other interventions to help. Again, the initial dose did not appear to affect this, as these patients got similar doses to those of patients who had a good response.
Significance for the EPI Dose Study:
- Doctors are using many different initial doses of epinephrine boluses for very low blood pressure.
- The response to the initial dose of epinephrine during life-threatening low blood pressure is associated with important clinical outcomes.
- Initial doses between 0.5 to 1 mcg/kg seem to benefit patients similarly.
Link to full article: https://pubmed.ncbi.nlm.nih.gov/29526678/