Variability in Vasoactive Medication use Across Pediatric Intensive Care Units: A PICU Data Collaborative Study, 2010–2022

Objective: Use of vasoactive medications is common in pediatric intensive care units (ICUs), however evidence to guide medication selection is limited likely resulting in practice variation. Our objective was to describe the use of vasoactive infusions across ICUs and sites. Design: Retrospective cohort study using the multi-institutional PICU Data Collaborative (PDC) database. Setting: Four pediatric ICUs (PICUs) and three cardiac ICUs (CICUs) from the U.S. participating in the PDC. Patients: Patients admitted to a participating ICU between 2010 and 2022 who received a vasoactive infusion within 7 days of ICU admission. Interventions: None. Measurements and Main Results: A vasoactive infusion was administered within the first 7 days of admission in 16,959 (22%) out of a total of 75,953 ICU encounters. CICU encounters comprised 20% of all ICU encounters but 60% of those with a vasoactive infusion. The most frequently used vasoactive medications were milrinone (63%) and epinephrine (59%). We found a statistically significant difference in the frequency of each vasoactive infusion between PICU sites (P < 0.001) and between CICU sites (P < 0.001). The median peak vasoactive inotrope score (VIS) was 10 [IQR 5.5–20] and 8 [IQR 5–12.5] among PICU and CICU encounters respectively. Conclusions: We found significant variability in the frequency of vasoactive infusion medication use between sites and type of ICU. Further investigation is needed to understand what impact this practice variability has on patient outcomes.