Cardiac rescue with enoximone in volume and catecholamine refractory septic shock.

Abstract

In December 2000 and February 2001, two children with suspected meningococcal disease were admitted to our pediatric intensive unit. Their Glasgow Meningococcal Septicaemia Prognostic score was 12 points. General treatment including antibiotics, steroids in case of meningitis, and fluid replacement, was performed. Despite appropriate volume replacement, intubation and ventilation, noradrenaline and adrenaline continuous infusions < or =1.0 microg/kg/min, and additional bolus infusions, cardiac output deteriorated within minutes in both children. Calcium and bicarbonate were given without sustained effect. Echocardiography demonstrated no pericardial effusion and shortening fraction was <10%. External cardiac massage had to be performed immediately in one case for electromechanical uncoupling. Both patients received a bolus of enoximone 2 mg/kg and 5 mg/kg body weight, respectively, followed by a continuous infusion of 20-23 microg/kg/min. Thereafter, both children had an adequate blood pressure and their shortening fraction increased to >30%. Within minutes, the catecholamine infusion could be reduced in both patients. The children completely recovered from their life-threatening situations. In patients with severe prolonged catecholamine and volume refractory endotoxin shock in Waterhouse-Friderichsen syndrome, even with electromechanical uncoupling and complete myocardial arrest, enoximone can immediately restore myocardial contractility.

• Authors: Hannelore I G Ringe, Verena Varnholt, Gerhard Gaedicke
• Journal: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (Pediatr Crit Care Med) Vol. 4 Issue 4 Pg. 471-5 (Oct 2003) ISSN: 1529-7535 [Print] United States
• PMID: 14525645 (Publication Type: Case Reports, Journal Article)

Chemical References

• Cardiotonic Agents
• Catecholamines
• Plasma Substitutes
• Enoximone

Topics

• Cardiac Output, Low (etiology, therapy)
• Cardiotonic Agents (therapeutic use)
• Catecholamines (therapeutic use)
• Child
• Child, Preschool
• Enoximone (therapeutic use)
• Female
• Humans
• Male
• Meningococcal Infections (complications)
• Plasma Substitutes (therapeutic use)
• Shock, Septic (complications)
• Treatment Failure