Resuscitation With Early Adrenaline Infusion for Children With Septic Shock: A Randomized Pilot Trial.
Pediatr Crit Care Med
; 25(2): 106-117, 2024 Feb 01.
Article
em En
| MEDLINE
| ID: mdl-38240535
ABSTRACT
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 11 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 MAINRESULTS:
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.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Choque Séptico
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Guideline
Limite:
Adolescent
/
Child
/
Child, preschool
/
Humans
/
Infant
/
Newborn
Idioma:
En
Revista:
Pediatr Crit Care Med
Assunto da revista:
PEDIATRIA
/
TERAPIA INTENSIVA
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Austrália