Resuscitation With Early Adrenaline Infusion for Children With Septic Shock: A Randomized Pilot Trial.

Autor:	Harley A; Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, QLD, Australia.; Department of Emergency Medicine, Gold Coast University Hospital, Southport, QLD, Australia.; Emergency Department Queensland Children`s Hospital, Brisbane, QLD, Australia.; School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.; School of Nursing, Centre of Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia.; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.; Children`s Critical Care Unit, Sunshine Coast University Hospital, Birtinya, QLD, Australia.; Paediatric Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia.; Intensive Care Research, Austin Hospital and Monash University, Melbourne, VIC, Australia.; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.; Australian and New Zealand Research Centre, Monash University, Melbourne, VIC, Australia.; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.; Pediatric and Neonatal Intensive Care Unit, and Children`s Research Center, University Children's Hospital Zurich, Zurich, Switzerland., George S; Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.; Department of Emergency Medicine, Gold Coast University Hospital, Southport, QLD, Australia.; School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia., Phillips N; Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.; Emergency Department Queensland Children`s Hospital, Brisbane, QLD, Australia., King M; Department of Emergency Medicine, Gold Coast University Hospital, Southport, QLD, Australia.; Emergency Department Queensland Children`s Hospital, Brisbane, QLD, Australia., Long D; Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.; School of Nursing, Centre of Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia., Keijzers G; Department of Emergency Medicine, Gold Coast University Hospital, Southport, QLD, Australia.; School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia., Lister P; Children`s Critical Care Unit, Sunshine Coast University Hospital, Birtinya, QLD, Australia., Raman S; Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.; Paediatric Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia., Bellomo R; Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, QLD, Australia.; Department of Emergency Medicine, Gold Coast University Hospital, Southport, QLD, Australia.; Emergency Department Queensland Children`s Hospital, Brisbane, QLD, Australia.; School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.; School of Nursing, Centre of Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia.; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.; Children`s Critical Care Unit, Sunshine Coast University Hospital, Birtinya, QLD, Australia.; Paediatric Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia.; Intensive Care Research, Austin Hospital and Monash University, Melbourne, VIC, Australia.; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.; Australian and New Zealand Research Centre, Monash University, Melbourne, VIC, Australia.; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.; Pediatric and Neonatal Intensive Care Unit, and Children`s Research Center, University Children's Hospital Zurich, Zurich, Switzerland., Gibbons K; Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia., Schlapbach LJ; Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.; Paediatric Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia.; Pediatric and Neonatal Intensive Care Unit, and Children`s Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
Jazyk:	angličtina
Zdroj:	Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2024 Feb 01; Vol. 25 (2), pp. 106-117. Date of Electronic Publication: 2024 Jan 19.
DOI:	10.1097/PCC.0000000000003351
Abstrakt:	Objectives: In children with septic shock, guidelines recommend resuscitation with 40-60 mL/kg of fluid boluses, yet there is a lack of evidence to support this practice. We aimed to determine the feasibility of a randomized trial comparing early adrenaline infusion with standard fluid resuscitation in children with septic shock. Design: Open-label parallel randomized controlled, multicenter pilot study. The primary end point was feasibility; the exploratory clinical endpoint was survival free of organ dysfunction by 28 days. Setting: Four pediatric Emergency Departments in Queensland, Australia. Patients: Children between 28 days and 18 years old with septic shock. Interventions: Patients were assigned 1:1 to receive a continuous adrenaline infusion after 20 mL/kg fluid bolus resuscitation (n = 17), or standard care fluid resuscitation defined as delivery of 40 to 60 mL/kg fluid bolus resuscitation prior to inotrope commencement (n = 23). Measurements and Main Results: Forty of 58 eligible patients (69%) were consented with a median age of 3.7 years (interquartile range [IQR], 0.9-12.1 yr). The median time from randomization to inotropes was 16 minutes (IQR, 12-26 min) in the intervention group, and 49 minutes (IQR, 29-63 min) in the standard care group. The median amount of fluid delivered during the first 24 hours was 0 mL/kg (IQR, 0-10.0 mL/kg) in the intervention group, and 20.0 mL/kg (14.6-28.6 mL/kg) in the standard group (difference, -20.0; 95% CI, -28.0 to -12.0). The number of days alive and free of organ dysfunction did not differ between the intervention and standard care groups, with a median of 27 days (IQR, 26-27 d) versus 26 days (IQR, 25-27 d). There were no adverse events reported associated with the intervention. Conclusions: In children with septic shock, a protocol comparing early administration of adrenaline versus standard care achieved separation between the study arms in relation to inotrope and fluid bolus use. Competing Interests: Drs. George’s, Long’s, and Schlapbach’s institutions received funding from Gold Coast Hospital Foundation. Drs. George’s, Long’s, and Schlapbach’s institutions received funding from the Emergency Medicine Foundation, Queensland. Drs. Long’s and Schlapbach’s institutions received funding from Financial Markets for Children Australia and a Children’s Health Queensland Study, Education and Research Trust Account grant. Dr. Lister’s institution received funding from the Hospital Foundation Charity. Dr. Schlapbach received funding from the National Health and Medical Research Council Practitioner Fellowship and the Children’s Hospital Foundation, Australia. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)
Databáze:	MEDLINE
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