Evolution of haemodynamics and outcome of fluid-refractory septic shock in children

Background Maintaining threshold values of cardiac output (CO) and systemic vascular resistance (SVR) when used as part of the American College of Critical Care Medicine (ACCM) haemodynamic protocol improves the outcomes in paediatric septic shock. Objective We observed the evolution of CO and SVR d...

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Bibliographic Details
Published in:Intensive care medicine 2013-09, Vol.39 (9), p.1602-1609
Main Authors: Deep, Akash, Goonasekera, Chulananda D. A., Wang, Yanzhong, Brierley, Joe
Format: Article
Language:English
Subjects:
Anesthesiology
Blood
Cardiac Output
Child, Preschool
Children
Cold
Critical care
Critical Care Medicine
Emergency Medicine
Female
Fluid Therapy
Hemodynamics
Humans
Intensive
Intensive care
Liver
Male
Medical examination
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Nosocomial infections
Pain Medicine
Pediatric intensive care
Pediatric Original
Pediatrics
Pneumology/Respiratory System
Prospective Studies
Sepsis
Septic shock
Shock, Septic - physiopathology
Shock, Septic - therapy
Transplantation
Ultrasonic imaging
Vascular Resistance
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Summary:Background Maintaining threshold values of cardiac output (CO) and systemic vascular resistance (SVR) when used as part of the American College of Critical Care Medicine (ACCM) haemodynamic protocol improves the outcomes in paediatric septic shock. Objective We observed the evolution of CO and SVR during the intensive care admission of children with fluid-refractory septic shock and report this together with the eventual outcomes. Design Prospective observational study. Setting Tertiary care Paediatric Intensive Care Unit (PICU) in London. Methods Children admitted in fluid refractory septic shock to the Intensive Care Unit over a period of 36 months were studied. Post liver re-transplant children and delayed septic shock admissions were excluded. A non-invasive ultrasound cardiac output monitor device (USCOM) was used to measure serial haemodynamics. Children were allocated at presentation into one of two categories: (1) hospital-acquired infection and (2) community-acquired infection. Vasopressor, inotrope or inodilator therapies were titrated to maintain threshold cardiovascular parameters as per the ACCM guidelines. Results Thirty-six children [19 male, mean age (SD) 6.78 (5.86) years] were admitted with fluid-refractory septic shock and studied. At presentation, all 18 children with hospital-acquired (HA) sepsis and 3 from among the community-acquired (CA) sepsis group were in ‘warm shock’ (SVRI 
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-013-3003-z