Role of echocardiography in reducing shock reversal time in pediatric septic shock: a randomized controlled trial
Abstract Objective: To evaluate the role of echocardiography in reducing shock reversal time in pediatric septic shock. Methods: A prospective study conducted in the pediatric intensive care unit of a tertiary care teaching hospital from September 2013 to May 2016. Ninety septic shock patients were randomized in a 1:1 ratio for comparing the serial echocardiography-guided therapy in the study group with the standard therapy in the control group regarding clinical course, timely treatment, and outcomes. Results: Shock reversal was significantly higher in the study group (89% vs. 67%), with significantly reduced shock reversal time (3.3 vs. 4.5 days). Pediatric intensive care unit stay in the study group was significantly shorter (8 ± 3 vs. 14 ± 10 days). Mortality due to unresolved shock was significantly lower in the study group. Fluid overload was significantly lower in the study group (11% vs. 44%). In the study group, inotropes were used more frequently (89% vs. 67%) and initiated earlier (12[0.5-24] vs. 24[6-72] h) with lower maximum vasopressor inotrope score (120[30-325] vs. 170[80-395]), revealing predominant use of milrinone (62% vs. 22%). Conclusion: Serial echocardiography provided crucial data for early recognition of septic myocardial dysfunction and hypovolemia that was not apparent on clinical assessment, allowing a timely management and resulting in shock reversal time reduction among children with septic shock.
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Sociedade Brasileira de Pediatria
2018
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oai:scielo:S0021-755720180001000312018-03-01Role of echocardiography in reducing shock reversal time in pediatric septic shock: a randomized controlled trialEL-Nawawy,Ahmed A.Abdelmohsen,Aly M.Hassouna,Hadir M. Echocardiography Pediatric septic shock Shock reversal time Inotropes Abstract Objective: To evaluate the role of echocardiography in reducing shock reversal time in pediatric septic shock. Methods: A prospective study conducted in the pediatric intensive care unit of a tertiary care teaching hospital from September 2013 to May 2016. Ninety septic shock patients were randomized in a 1:1 ratio for comparing the serial echocardiography-guided therapy in the study group with the standard therapy in the control group regarding clinical course, timely treatment, and outcomes. Results: Shock reversal was significantly higher in the study group (89% vs. 67%), with significantly reduced shock reversal time (3.3 vs. 4.5 days). Pediatric intensive care unit stay in the study group was significantly shorter (8 ± 3 vs. 14 ± 10 days). Mortality due to unresolved shock was significantly lower in the study group. Fluid overload was significantly lower in the study group (11% vs. 44%). In the study group, inotropes were used more frequently (89% vs. 67%) and initiated earlier (12[0.5-24] vs. 24[6-72] h) with lower maximum vasopressor inotrope score (120[30-325] vs. 170[80-395]), revealing predominant use of milrinone (62% vs. 22%). Conclusion: Serial echocardiography provided crucial data for early recognition of septic myocardial dysfunction and hypovolemia that was not apparent on clinical assessment, allowing a timely management and resulting in shock reversal time reduction among children with septic shock.info:eu-repo/semantics/openAccessSociedade Brasileira de PediatriaJornal de Pediatria v.94 n.1 20182018-02-01info:eu-repo/semantics/articletext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572018000100031en10.1016/j.jped.2017.02.005 |
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EL-Nawawy,Ahmed A. Abdelmohsen,Aly M. Hassouna,Hadir M. |
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EL-Nawawy,Ahmed A. Abdelmohsen,Aly M. Hassouna,Hadir M. Role of echocardiography in reducing shock reversal time in pediatric septic shock: a randomized controlled trial |
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EL-Nawawy,Ahmed A. Abdelmohsen,Aly M. Hassouna,Hadir M. |
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EL-Nawawy,Ahmed A. |
title |
Role of echocardiography in reducing shock reversal time in pediatric septic shock: a randomized controlled trial |
title_short |
Role of echocardiography in reducing shock reversal time in pediatric septic shock: a randomized controlled trial |
title_full |
Role of echocardiography in reducing shock reversal time in pediatric septic shock: a randomized controlled trial |
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Role of echocardiography in reducing shock reversal time in pediatric septic shock: a randomized controlled trial |
title_full_unstemmed |
Role of echocardiography in reducing shock reversal time in pediatric septic shock: a randomized controlled trial |
title_sort |
role of echocardiography in reducing shock reversal time in pediatric septic shock: a randomized controlled trial |
description |
Abstract Objective: To evaluate the role of echocardiography in reducing shock reversal time in pediatric septic shock. Methods: A prospective study conducted in the pediatric intensive care unit of a tertiary care teaching hospital from September 2013 to May 2016. Ninety septic shock patients were randomized in a 1:1 ratio for comparing the serial echocardiography-guided therapy in the study group with the standard therapy in the control group regarding clinical course, timely treatment, and outcomes. Results: Shock reversal was significantly higher in the study group (89% vs. 67%), with significantly reduced shock reversal time (3.3 vs. 4.5 days). Pediatric intensive care unit stay in the study group was significantly shorter (8 ± 3 vs. 14 ± 10 days). Mortality due to unresolved shock was significantly lower in the study group. Fluid overload was significantly lower in the study group (11% vs. 44%). In the study group, inotropes were used more frequently (89% vs. 67%) and initiated earlier (12[0.5-24] vs. 24[6-72] h) with lower maximum vasopressor inotrope score (120[30-325] vs. 170[80-395]), revealing predominant use of milrinone (62% vs. 22%). Conclusion: Serial echocardiography provided crucial data for early recognition of septic myocardial dysfunction and hypovolemia that was not apparent on clinical assessment, allowing a timely management and resulting in shock reversal time reduction among children with septic shock. |
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Sociedade Brasileira de Pediatria |
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2018 |
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http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572018000100031 |
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