Fluid Bolus Over 15–20 Versus 5–10 Minutes Each in the First Hour of Resuscitation in Children With Septic Shock: A Randomized Controlled Trial*

Sankar, Jhuma; Ismail, Javed; Sankar, M. Jeeva; C.P., Suresh; Meena, Rameshwar S.

doi:10.1097/pcc.0000000000001269

Cited by 59 publications

(40 citation statements)

References 28 publications

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“…Three RCTs of different volume resuscitation strategies in children with septic shock in settings in which advanced supportive care (e.g., intubation, mechanical ventilation, and intensive care) was accessible have been published [180][181][182]. These studies have a combined total of only 316 children and showed no difference in mortality between the restrictive and liberal fluid resuscitation groups (Supplemental Table 4 In geographic settings in which advanced supportive care, including mechanical ventilation, is limited and/ or intensive care is not routinely accessible, the only large-scale RCT of different bolus fluid volume resuscitation strategies in severe infection in children was the Fluid Expansion as Supportive Therapy (FEAST) study (Supplemental Table 4 and Supplemental Fig.…”

Section: We Recommend Removal Of Intravascular Access Devices That Armentioning

confidence: 99%

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

et al. 2020

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Objectives: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction.Design: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those The Society of Critical Care Medicine guidelines are intended for general information only, are not medical advice, and do not replace professional advice, which should be sought for any medical condition. The full disclaimer for guidelines can be accessed at https ://www.sccm.org/Resea rch/Guide lines /Guide lines . panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. Methods:The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. Results:The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 52 research priorities were identified. Conclusions:A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research. S14 the group heads, panel members, and methodologists. Searches utilized ...

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Section: We Recommend Removal Of Intravascular Access Devices That Armentioning

confidence: 99%

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

et al. 2020

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“…2,3 Tertiary care teaching hospitals of our country report mortality of >40%. [4][5][6][7] Although septic shock patients commonly have myocardial dysfunction [8][9][10][11][12][13][14][15] and is associated with high mortality, 12 it is reversible by 7-10 days among survivors. [16][17][18] Myocardial dysfunction is conventionally assessed by echocardiography.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Study of CPK-MB and Echocardiographic Measures of Myocardial Dysfunction in Pediatric Sepsis: Are Patients with Shock Different from Those without?

Baranwal

Deepthi²,

Rohit

et al. 2020

Indian Journal of Critical Care Medicine

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Background: Sepsis-induced myocardial dysfunction has implications on outcome. For lack of echocardiography in resource-limited settings, myocardial biomarkers may be an alternative monitoring tool. Objective: This study was planned to explore the longitudinal behavior of creatine phosphokinase-MB (CPK-MB) in children with sepsis with and without shock, and its correlation with clinical and echocardiographic parameters over the first 10 days. Design: Prospective observational study. Setting: Tertiary care hospital in a lower-middle-income economy of South Asia. Patients: Children (3 months to 12 years) with nonshock sepsis (NSS) (n = 40) and septic shock survivors (SSSs) (n = 40) after optimal resuscitation. Patients with catecholamine refractory shock, preexisting heart disease, and cardiorespiratory event within the past 1 month were excluded from the study. Measurements and main results: Pediatric logistic organ dysfunction (PeLOD) score, vasoactive inotrope score (VIS), CPK-MB, and echocardiographic measures of myocardial function were recorded on days 1, 3, 7, and 10. Echocardiography was repeated at 1 month. Both groups were similar at baseline. The SSSs had higher CPK-MB (180 vs 53 IU/L; p < 0.001) and PeLOD score (2 ± 0.4 vs 11.7 ± 5.1, p < 0.001) on day 1 compared to the NSS children. More than half of the SSS and none of the NSS patients had myocardial dysfunction. Reduction in CPK-MB over 10 days correlated well with improvement in PeLOD (p < 0.01), VIS (p = 0.04), and echocardiographic measures of myocardial dysfunction (p < 0.05) among SSSs. At 1 month follow-up, all had normal echocardiography. Conclusion: The SSSs had markedly elevated CPK-MB, and its fall paralleled the improvement in clinical status and myocardial dysfunctions. The CPK-MB could be a potential monitoring tool for septic cardiomyopathy in resource-limited settings.

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“…observaron que la utilización de bolos en menos de 10 minutos presentaba mayores riesgos de necesitar IE que administrarlos en 15-20 minutos. 34 Se sugiere un tiempo límite de 30 minutos como meta más razonable.…”

Section: Tratamiento (Figura 1)unclassified

Recomendaciones para el manejo del shock séptico en niños durante la primera hora (segunda parte)

2019

Arch Argent Pediat

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Fluid Bolus Over 15–20 Versus 5–10 Minutes Each in the First Hour of Resuscitation in Children With Septic Shock: A Randomized Controlled Trial*

Cited by 59 publications

References 28 publications

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

Longitudinal Study of CPK-MB and Echocardiographic Measures of Myocardial Dysfunction in Pediatric Sepsis: Are Patients with Shock Different from Those without?

Recomendaciones para el manejo del shock séptico en niños durante la primera hora (segunda parte)

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