Moharana Suman Sudha, Av Lalitha, Ghosh Santu
Department of Pediatric Critical Care, IMS and SUM Hospital, Bhubaneswar, India.
Department of Pediatric Critical Care, St Johns Medical College and Hospital, Bengaluru, India.
Crit Care Explor. 2025 Mar 31;7(4):e1242. doi: 10.1097/CCE.0000000000001242. eCollection 2025 Apr 1.
To evaluate the difference in the resuscitation fluid volume in the initial 6 hours in pediatric septic shock between those undergoing noninvasive continuous hemodynamic monitoring with electrocardiometry in addition to clinical monitoring vs. clinical monitoring alone.
Randomized control trial.
PICU in a tertiary care hospital.
Children from 2 months to 18 years with sepsis and unresolved shock after the initial fluid bolus (FB).
Children were randomized to one of the two groups, that is, electrocardiometry with clinical monitoring group (group B) and clinical monitoring alone group (group A). In group B, electrocardiometry variables (cardiac index and systemic vascular resistance index) along with clinical monitoring were used to guide FB, as well as selection and titration of vasoactive agents. Clinical parameters were used to initiate and titrate fluid resuscitation and vasoactive therapy in group A as per standard guidelines.
One hundred nineteen children were enrolled in the study: 60 in group A and 59 in group B. There was a significantly higher requirement for resuscitation fluid volume (mean ± sd) within the initial 6 hours in the group A (30 ± 8.2 mL/kg) as compared with group B (22 ± 9.2 mL/kg). Similarly, maintenance along with resuscitation fluid volume (mean ± sd) administration (56 ±13 vs. 46 ±10.7, p < 0.001) was higher in group A in the first 24 hours of enrollment. Vasoactive therapy initiation was earlier in group B as compared with group A (37 ± 10.14 vs. 47.33 ± 12.41 min) with lower fluid overload percentage (2.98% vs. 1.7%) in this group. However, there was no difference in time to shock resolution, 28-day ICU-free days, hospital-free days, and mortality.
Advanced hemodynamic monitoring with electrocardiometry along with clinical assessment led to a restrictive fluid strategy in addition to minimizing the risk of fluid overload.
评估在小儿感染性休克初始6小时内，除临床监测外接受无创连续血流动力学监测（采用心电图法）的患儿与仅接受临床监测的患儿在复苏液体量上的差异。
随机对照试验。
一家三级护理医院的儿科重症监护病房。
年龄在2个月至18岁之间，在初始液体冲击（FB）后患有脓毒症且休克未缓解的儿童。
将儿童随机分为两组之一，即心电图法联合临床监测组（B组）和仅临床监测组（A组）。在B组中，心电图变量（心脏指数和全身血管阻力指数）以及临床监测用于指导液体冲击，以及血管活性药物的选择和滴定。在A组中，根据标准指南，使用临床参数启动和滴定液体复苏及血管活性治疗。
119名儿童参与了该研究：A组60名，B组59名。与B组（22±9.2 mL/kg）相比，A组在初始6小时内对复苏液体量（均值±标准差）的需求显著更高（30±8.2 mL/kg）。同样，在入组的前24小时内，A组维持及复苏液体量（均值±标准差）的给药量（56±13对46±10.7，p<0.001）更高。与A组相比，B组血管活性治疗启动更早（37±10.14对47.33±12.41分钟），且该组液体超负荷百分比更低（2.98%对1.7%）。然而，在休克缓解时间、28天无ICU天数、无住院天数和死亡率方面没有差异。
心电图法联合临床评估的高级血流动力学监测除了可将液体超负荷风险降至最低外，还导致了一种限制性液体策略。
