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Drugs with inotropic and vasopressive effects used for management of a potential pediatric organ donor

Drugs with inotropic and vasopressive effects used for management of a potential pediatric organ donor
Drug Dose Comments

Milrinone

 

0.25 to 0.75 micrograms/kg per minute IV

Loading dose: 50 micrograms/kg

Hypotension can occur

Dopamine 2 to 20 micrograms/kg per minute IV Titrate to desired blood pressure

Dobutamine

 

2 to 20 micrograms/kg per minute IV Titrate to desired blood pressure
Epinephrine 0.1 to 1 micrograms/kg per minute IV Titrate to desired blood pressure

Norepinephrine

 

0.05 to 2 micrograms/kg per minute IV Titrate to desired blood pressure

Phenylephrine

 

0.1 to 0.5 micrograms/kg per minute IV

Bolus: 5 to 20 micrograms/kg

Titrate to desired blood pressure

Vasopressin

 

0.3 to 2 milliunits/kg per minute IV

Note: Dosing is different for treatment of diabetes insipidus

Limited data in children

Not recommended as first-line therapy

Titrate to desired blood pressure

Inotropic agents are used for low cardiac output states to improve end organ perfusion. These agents should be titrated to maintain a normal blood pressure for age. Blood pressure alone does not indicate adequate tissue perfusion. Serum biomarkers such as lactate should be followed as inotropic support is titrated.
IV: Intravenous
Reproduced with permission from: Nakagawa, TA. Pediatric donor management guidelines. NATCO, The Organization for Transplant Professionals, 2008. p.5.
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