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Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome.
Pediatrics. 2003 Oct; 112(4):793-9.Ped

Abstract

OBJECTIVE

Experimental and clinical studies of septic shock support the concept that early resuscitation with fluid and inotropic therapies improves survival in a time-dependent manner. The new American College of Critical Care Medicine-Pediatric Advanced Life Support (ACCM-PALS) Guidelines for hemodynamic support of newborns and children in septic shock recommend this therapeutic approach. The objective of this study was to determine whether early septic shock reversal and use of resuscitation practice consistent with the new ACCM-PALS Guidelines by community physicians is associated with improved outcome.

METHODS

A 9-year (January 1993-December 2001) retrospective cohort study was conducted of 91 infants and children who presented to local community hospitals with septic shock and required transport to Children's Hospital of Pittsburgh. Shock reversal (defined by return of normal systolic blood pressure and capillary refill time), resuscitation practice concurrence with ACCM-PALS Guidelines, and hospital mortality were measured.

RESULTS

Overall, 26 (29%) patients died. Community physicians successfully achieved shock reversal in 24 (26%) patients at a median time of 75 minutes (when the transport team arrived at the patient's bedside), which was associated with 96% survival and >9-fold increased odds of survival (9.49 [1.07-83.89]). Each additional hour of persistent shock was associated with >2-fold increased odds of mortality (2.29 [1.19-4.44]). Nonsurvivors, compared with survivors, were treated with more inotropic therapies (dopamine/dobutamine [42% vs 20%] and epinephrine/norepinephrine [42% vs 6%]) but not increased fluid therapy (median volume; 32.9 mL/kg vs 20.0 mL/kg). Resuscitation practice was consistent with ACCM-PALS Guidelines in only 27 (30%) patients; however, when practice was in agreement with guideline recommendations, a lower mortality was observed (8% vs 38%).

CONCLUSIONS

Early recognition and aggressive resuscitation of pediatric-neonatal septic shock by community physicians can save lives. Educational programs that promote ACCM-PALS recommended rapid, stepwise escalations in fluid as well as inotropic therapies may have value in improving outcomes in these children.

Authors+Show Affiliations

Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Review

Language

eng

PubMed ID

14523168

Citation

Han, Yong Y., et al. "Early Reversal of Pediatric-neonatal Septic Shock By Community Physicians Is Associated With Improved Outcome." Pediatrics, vol. 112, no. 4, 2003, pp. 793-9.
Han YY, Carcillo JA, Dragotta MA, et al. Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics. 2003;112(4):793-9.
Han, Y. Y., Carcillo, J. A., Dragotta, M. A., Bills, D. M., Watson, R. S., Westerman, M. E., & Orr, R. A. (2003). Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics, 112(4), 793-9.
Han YY, et al. Early Reversal of Pediatric-neonatal Septic Shock By Community Physicians Is Associated With Improved Outcome. Pediatrics. 2003;112(4):793-9. PubMed PMID: 14523168.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. AU - Han,Yong Y, AU - Carcillo,Joseph A, AU - Dragotta,Michelle A, AU - Bills,Debra M, AU - Watson,R Scott, AU - Westerman,Mark E, AU - Orr,Richard A, PY - 2003/10/3/pubmed PY - 2003/10/18/medline PY - 2003/10/3/entrez SP - 793 EP - 9 JF - Pediatrics JO - Pediatrics VL - 112 IS - 4 N2 - OBJECTIVE: Experimental and clinical studies of septic shock support the concept that early resuscitation with fluid and inotropic therapies improves survival in a time-dependent manner. The new American College of Critical Care Medicine-Pediatric Advanced Life Support (ACCM-PALS) Guidelines for hemodynamic support of newborns and children in septic shock recommend this therapeutic approach. The objective of this study was to determine whether early septic shock reversal and use of resuscitation practice consistent with the new ACCM-PALS Guidelines by community physicians is associated with improved outcome. METHODS: A 9-year (January 1993-December 2001) retrospective cohort study was conducted of 91 infants and children who presented to local community hospitals with septic shock and required transport to Children's Hospital of Pittsburgh. Shock reversal (defined by return of normal systolic blood pressure and capillary refill time), resuscitation practice concurrence with ACCM-PALS Guidelines, and hospital mortality were measured. RESULTS: Overall, 26 (29%) patients died. Community physicians successfully achieved shock reversal in 24 (26%) patients at a median time of 75 minutes (when the transport team arrived at the patient's bedside), which was associated with 96% survival and >9-fold increased odds of survival (9.49 [1.07-83.89]). Each additional hour of persistent shock was associated with >2-fold increased odds of mortality (2.29 [1.19-4.44]). Nonsurvivors, compared with survivors, were treated with more inotropic therapies (dopamine/dobutamine [42% vs 20%] and epinephrine/norepinephrine [42% vs 6%]) but not increased fluid therapy (median volume; 32.9 mL/kg vs 20.0 mL/kg). Resuscitation practice was consistent with ACCM-PALS Guidelines in only 27 (30%) patients; however, when practice was in agreement with guideline recommendations, a lower mortality was observed (8% vs 38%). CONCLUSIONS: Early recognition and aggressive resuscitation of pediatric-neonatal septic shock by community physicians can save lives. Educational programs that promote ACCM-PALS recommended rapid, stepwise escalations in fluid as well as inotropic therapies may have value in improving outcomes in these children. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/14523168/Early_reversal_of_pediatric_neonatal_septic_shock_by_community_physicians_is_associated_with_improved_outcome_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=14523168 DB - PRIME DP - Unbound Medicine ER -