Pediatric Vasoactive Drug Administration


  • Hemodynamic compromise
  • Circulatory compromise

Clinical Data:

Inotropic support should be considered only after adequate fluid resuscitation.

NOTE: Use large vein to prevent possibility of extravasation.


  1. Administer on infusion pump.
  2. Document infusion concentration, drip rate, and medication dose in mcg/kg/minute on the transfer record.
  3. Start at low end or middle range of recommended dose, titrate per desired effect and monitor for undesirable effects.
  4. If hemodynamic/circulatory compromise persists after adequate fluid resuscitation, initiate vasoactive therapy:
  1. Dopamine (Premix 800mg/250mL)
    1. 2-20 mcg/kg/minute: Dose related effects.
    2. Recommended primarily for hypotension and shock for inotropic effects.
    3. 2-5 mcg/kg/minute: Primarily dopaminergic
    4. 5-10 mcg/kg/minute: Inotropic beta effects
    5. 10-20 mcg/kg/minute: Vasoconstrictive effects with increasing alpha effects
    6. More than 20 mcg/kg/minute: not indicated as it may cause increased myocardial oxygen consumption and offset desirable effects.

  2. Norepinephrine (Levophed)
    1. < 40 kg: 0.01 – 1 mcg/kg/minute, titrate to desired effect.

      Max dose 2 mcg/kg/minute.

    2. ≥ 40 kg: 0.5 - 1 mcg/minute, titrate to desired effect.

      Max dose 30 mcg/min

    3. For treatment of warm shock refractory to fluid and Dopamine
    4. Strong alpha effects (vasoconstriction) and less beta effects (inotropic and chronotropic)

    NOTE: Not recommended for dilution in normal saline.

  3. Epinephrine
    1. < 50 kg: 0.05 – 1 mcg/kg/minute
    2. ≥ 50 kg: 1 – 10 mcg /min
    3. Potent alpha effects with vasoconstriction, increased heart rate, and blood pressure.
    4. Recommended for cold shock (decreased SVR)

NOTE: In patients with congenital heart diseases, high dose Epinephrine or Norepinephrine can be detrimental.


  1. Bierley J, Carcillo J, Choong K, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009; 37(2):666–688.

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