Gupta Shalu, Kumar Virendra
Department of Pediatrics, ESIC Hospital and Medical College, Faridabad, Haryana, India.
Division of Pediatric Critical Care, Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, Delhi, India.
Indian J Crit Care Med. 2021 Aug;25(8):928-933. doi: 10.5005/jp-journals-10071-23954.
The role of vasoactive medications in septic shock is well-defined, but the appropriate time of initiation of these medications in reference to fluid boluses is not clear. We planned to study prospectively the practices and outcome of initiation of vasoactive infusions with respect to resuscitation fluids boluses in pediatric septic shock. Children aged 1 month to 18 years diagnosed with septic shock were enrolled to receive fluid resuscitation boluses along with vasoactive drugs. The primary outcome was to look at various practices of the initiation of vasoactive infusions; accordingly, patients were categorized into three groups: N1 received vasoactive infusions after completion of the first bolus (20 mL/kg), N2 after the second (40 mL/kg), and N3 after the third fluid (60 mL/kg) bolus. Secondary outcomes were to compare the time taken, amount of fluid required to achieve hemodynamic stability, total fluid required, and complications in the first 24 hours of treatment and mortality. Hundred children were enrolled and grouped into N1, N2, and N3 with 46, 10, and 44 patients, respectively. The volume of fluid required to achieve the resolution of shock in N1 (40 ± 10 mL/kg) was significantly less than in N2 (70 ± 10 mL/kg) and N3 (70 ± 20 mL/kg); = 0.02. The time taken to achieve hemodynamic stability was significantly less in N1 (115 ± 45 minutes) than in N2 (196 ± 32 minutes) and N3 (212 ± 44 minutes); = 0.02. The volume of intravenous fluid required in the first 24 hours ( = 0.02) and complications were lower in the N1 group ( = 0.04). No statistical difference in mortality was seen. Early initiation of vasoactive infusions (after the first bolus) resulted in less total fluid volume, lesser time to achieve hemodynamic stability, less fluid boluses, less length of stay in the pediatric intensive care unit, and lesser complications in the first 24 hours. Early initiation of vasoactive infusions-after completion of the first fluid bolus resulted in less need for further fluid boluses, lesser time for shock resolution, lesser fluid overload, and less PICU stay-in pediatric septic shock. Karanvir, Gupta S, Kumar V. Practices of Initiation of Vasoactive Drugs in Relation to Resuscitation Fluids in Children with Septic Shock: A Prospective Observational Study. Indian J Crit Care Med 2021;25(8):928-933.
血管活性药物在感染性休克中的作用已明确，但这些药物相对于液体冲击疗法的恰当起始时间尚不清楚。我们计划前瞻性研究小儿感染性休克中血管活性输注起始操作及其与复苏液体冲击疗法相关的结果。1个月至18岁诊断为感染性休克的儿童被纳入研究，接受液体复苏冲击疗法及血管活性药物治疗。主要结局是观察血管活性输注起始的各种操作；相应地，患者被分为三组：N1组在首次冲击量（20 mL/kg）完成后开始血管活性输注，N2组在第二次（40 mL/kg）后开始，N3组在第三次液体（60 mL/kg）冲击量后开始。次要结局是比较达到血流动力学稳定所需时间、达到血流动力学稳定所需液体量、总液体需求量、治疗最初24小时内的并发症及死亡率。100名儿童被纳入并分别分组到N1、N2和N3组，每组分别有46、10和44例患者。N1组（40±10 mL/kg）达到休克缓解所需液体量显著少于N2组（70±10 mL/kg）和N3组（70±20 mL/kg）；P = 0.02。N1组（115±45分钟）达到血流动力学稳定所需时间显著短于N2组（196±32分钟）和N3组（212±44分钟）；P = 0.02。N1组在最初24小时所需静脉液体量（P = 0.02）及并发症较少（P = 0.04）。死亡率未见统计学差异。早期起始血管活性输注（首次冲击量后）导致总液体量更少、达到血流动力学稳定所需时间更短、液体冲击量更少、在儿科重症监护病房的住院时间更短以及最初24小时内并发症更少。在小儿感染性休克中，首次液体冲击量完成后早期起始血管活性输注导致对进一步液体冲击量需求减少、休克缓解时间更短、液体超负荷更少以及儿科重症监护病房住院时间更短。卡兰维尔、古普塔S、库马尔V。小儿感染性休克中血管活性药物起始操作与复苏液体的关系：一项前瞻性观察研究。《印度重症监护医学杂志》2021年；25(8):928 - 933。
