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01.06.2008 | Pediatric Original

ACCM/PALS haemodynamic support guidelines for paediatric septic shock: an outcomes comparison with and without monitoring central venous oxygen saturation

verfasst von: Cláudio F. de Oliveira, Débora S. F. de Oliveira, Adriana F. C. Gottschald, Juliana D. G. Moura, Graziela A. Costa, Andréa C. Ventura, José Carlos Fernandes, Flávio A. C. Vaz, Joseph A. Carcillo, Emanuel P. Rivers, Eduardo J. Troster

Erschienen in: Intensive Care Medicine | Ausgabe 6/2008

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Abstract

Introduction

The ACCM/PALS guidelines address early correction of paediatric septic shock using conventional measures. In the evolution of these recommendations, indirect measures of the balance between systemic oxygen delivery and demands using central venous or superior vena cava oxygen saturation (ScvO₂ ≥ 70%) in a goal-directed approach have been added. However, while these additional goal-directed endpoints are based on evidence-based adult studies, the extrapolation to the paediatric patient remains unvalidated.

Objective

The purpose of this study was to compare treatment according to ACCM/PALS guidelines, performed with and without ScvO₂ goal-directed therapy, on the morbidity and mortality rate of children with severe sepsis and septic shock.

Design, participants and interventions

Children and adolescents with severe sepsis or fluid-refractory septic shock were randomly assigned to ACCM/PALS with or without ScvO₂ goal-directed resuscitation.

Measurements

Twenty-eight-day mortality was the primary endpoint.

Results

Of the 102 enrolled patients, 51 received ACCM/PALS with ScvO₂ goal-directed therapy and 51 received ACCM/PALS without ScvO₂ goal-directed therapy. ScvO₂ goal-directed therapy resulted in less mortality (28-day mortality 11.8% vs. 39.2%, p = 0.002), and fewer new organ dysfunctions (p = 0.03). ScvO₂ goal-directed therapy resulted in more crystalloid (28 (20–40) vs. 5 (0–20) ml/kg, p < 0.0001), blood transfusion (45.1% vs. 15.7%, p = 0.002) and inotropic (29.4% vs. 7.8%, p = 0.01) support in the first 6 h.

Conclusions

This study supports the current ACCM/PALS guidelines. Goal-directed therapy using the endpoint of a ScvO₂ ≥ 70% has a significant and additive impact on the outcome of children and adolescents with septic shock.

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Titel: ACCM/PALS haemodynamic support guidelines for paediatric septic shock: an outcomes comparison with and without monitoring central venous oxygen saturation
verfasst von: Cláudio F. de Oliveira
Débora S. F. de Oliveira
Adriana F. C. Gottschald
Juliana D. G. Moura
Graziela A. Costa
Andréa C. Ventura
José Carlos Fernandes
Flávio A. C. Vaz
Joseph A. Carcillo
Emanuel P. Rivers
Eduardo J. Troster
Publikationsdatum: 01.06.2008
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 6/2008
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1085-9

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Abstract

Introduction

Objective

Design, participants and interventions

Measurements

Results

Conclusions

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