Use of vasopressor in pediatric shock management across the world: A scoping reviews of practices, outcomes and gaps in 2026

Emerging evidence supports earlier vasopressor use in pediatric shock, but significant variability in practice and knowledge gaps persist.

Summary and findings

This scoping review synthesized global evidence on vasopressor use in pediatric shock management, analyzing practices and outcomes from 12 studies. It highlights a shift towards earlier initiation of vasoactive agents after a 20 mL/kg fluid bolus. The review also notes the association of vasopressin use with significant hyponatremia, particularly in neonates.

Abstract

<title>Abstract</title> <p>Background Pediatric shock is a critical condition requiring urgent intervention to restore adequate tissue perfusion. Vasopressors are central to shock management, yet clinical practices vary significantly worldwide. This scoping review aims to synthesize global evidence on vasopressor use in pediatric shock, focusing on current practices, clinical outcomes, and research gaps. Methods Following the Joanna Briggs Institute (JBI) methodology, we systematically searched six databases (PubMed, CINAHL, Science Direct, Cochrane, Embase, and Google Scholar) for studies published from 2020 to 2025. The PCC (Population–Concept–Context) framework guided the inclusion of 12 studies involving pediatric patients with various shock types receiving vasopressor therapy in different healthcare settings. Results The findings indicate growing support for early initiation of vasoactive agents often after 20 mL/kg fluid bolus rather than the traditional 40–60 mL/kg threshold. This approach consistently led to reduced fluid overload, shorter PICU stays, and fewer complications. Peripheral administration of vasopressors, once avoided, is now increasingly accepted as safe and practical, particularly during transport or emergency settings. Despite this, no clear consensus exists on the optimal first-line agent; while norepinephrine shows promise, epinephrine and dopamine remain commonly used. Additionally, vasopressin use has been associated with significant hyponatremia, especially in neonates, underscoring the need for better safety protocols. Knowledge gaps among healthcare providers, along with inconsistent adherence to pediatric sepsis guidelines, highlight systemic barriers in care delivery. Conclusion While emerging evidence favors earlier and flexible vasopressor use, significant variability in practice and persistent gaps in pediatric specific research hinder the establishment of standardized protocols. There is an urgent need for randomized controlled trials, improved provider education, and context-specific guidelines to optimize outcomes in pediatric shock management.</p>

Limitations

Not reported in abstract.

Elsewhere in the Vasopressin corpus