Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition.

Autor: Morin L; Paediatric Intensive Care Unit, Paris South University Hospitals, AP-HP, 78 Rue du General Leclerc, 94275, Le Kremlin-Bicêtre, France., Ray S; Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK., Wilson C; Paediatric Intensive Care Unit, Saint-Mary's Hospital, London, UK., Remy S; Paediatric Intensive Care Unit, Lyon University Hospitals, Bron, France., Benissa MR; Paediatric Intensive Care Unit, Paris South University Hospitals, AP-HP, 78 Rue du General Leclerc, 94275, Le Kremlin-Bicêtre, France., Jansen NJG; Paediatric Intensive Care Unit, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands., Javouhey E; Paediatric Intensive Care Unit, Lyon University Hospitals, Bron, France., Peters MJ; Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK., Kneyber M; Paediatric Intensive Care Unit, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands.; Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), The University of Groningen, Groningen, The Netherlands., De Luca D; Neonatal Intensive Care Unit, Paris South University Hospitals, AP-HP, Clamart, France., Nadel S; Paediatric Intensive Care Unit, Saint-Mary's Hospital, London, UK., Schlapbach LJ; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, Australia.; Paediatric Critical Care Research Group, Mater Research, The University of Queensland, Brisbane, Australia.; Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Maclaren G; Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Melbourne, Australia.; Cardiothoracic Intensive Care Unit, National University Health System, Singapore, Singapore., Tissieres P; Paediatric Intensive Care Unit, Paris South University Hospitals, AP-HP, 78 Rue du General Leclerc, 94275, Le Kremlin-Bicêtre, France. pierre.tissieres@aphp.fr.; Institute of Integrative Biology of the Cell, Paris Saclay University, Saint-Aubin, France. pierre.tissieres@aphp.fr.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2016 Dec; Vol. 42 (12), pp. 1948-1957. Date of Electronic Publication: 2016 Oct 05.
DOI: 10.1007/s00134-016-4574-2
Abstrakt: Purpose: Although overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and neonatal intensive care (ESPNIC) experts' definition of paediatric RSS.
Methods: We conducted a two-round Delphi study followed by an observational multicentre retrospective study. One hundred and fourteen paediatric intensivists answered a clinical case-based, two-round Delphi survey, identifying clinical items consistent with RSS. Multivariate analysis of these items in a development single-centre cohort (70 patients, 30 % mortality) facilitated development of RSS definitions based on either a bedside or computed severity score. Both scores were subsequently tested in a validation cohort (six centres, 424 patients, 11.6 % mortality).
Results: From the Delphi process, the draft definition included evidence of myocardial dysfunction and high blood lactate levels despite high vasopressor treatment. When assessed in the development population, each item was independently associated with the need for extracorporeal life support (ECLS) or death. Resultant bedside and computed septic shock scores had high discriminative power against the need for ECLS or death, with areas under the receiver operating characteristics curve of 0.920 (95 % CI 0.89-0.94), and 0.956 (95 % CI 0.93-0.97), respectively. RSS defined by a bedside score equal to or higher than 2 and a computed score equal to or higher than 3.5 was associated with a significant increase in mortality.
Conclusions: This ESPNIC definition of RSS accurately identifies children with the most severe form of septic shock.
Competing Interests: Compliance with ethical standards Funding None. Conflicts of interest Dr. Javouhey reports grants from CSL Behring, personal fees from Gambro-Baxter, outside the submitted work. Dr. Tissieres reports grants from Merieux Foundation, non-financial support from Chiesi Inc, outside the submitted work. All other authors declare that they have no conflict of interest.
Databáze: MEDLINE
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