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A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Paediatric community-acquired septic shock: results from the REPEM network study
P Van de Voorde1, B Emerson, B Gomez
1Paediatric Intensive care and Emergency Medicine, 1K12IC, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium. patrick.vandevoorde@ugent.be
Insights
Severe paediatric septic shock has a good outcome, with organ dysfunction and treatment, not predisposition, predicting results. Early interventions may prevent intensive care needs in children.
Area of Science:
- Pediatric Critical Care Medicine
- Emergency Medicine
- Infectious Diseases
Background:
- Severe sepsis and septic shock are significant causes of pediatric morbidity and mortality.
- Understanding the epidemiology and outcomes of pediatric septic shock in real-world settings is crucial for improving patient care.
- Early goal-directed therapy (EGDT) is a potential treatment strategy, but its feasibility in children requires further investigation.
Purpose of the Study:
- To describe the "true world" picture of severe pediatric community-acquired septic shock.
- To establish the feasibility of a future prospective trial on early goal-directed therapy in children.
Main Methods:
- A retrospective screening of 270,461 pediatric emergency department (ED) consultations across 16 EDs in 12 countries.
- Inclusion of children with severe sepsis and signs of decreased perfusion over a 6- to 12-month period.
- Analysis of patient demographics, comorbidities, treatment interventions, and outcomes, including mortality and Paediatric Overall Performance Category (POPC).
Main Results:
- 176 cases of severe pediatric septic shock were identified, with 35.8% having significant comorbidity.
- Intensive care admission was required for 65.7%, mechanical ventilation for 25.9%, and vasoactive medications for 42.9%.
- Overall mortality was 4.5%. Severe outcome was significantly related to desaturation, fluid administration in the first 6 hours, mechanical ventilation, vasoactive support, dobutamine use, higher lactate, and lower base excess, but not to predisposition, infection, or host response (PIRO concept).
Conclusions:
- The outcome for severe pediatric septic shock in this sample was favorable.
- Early treatment may prevent the need for intensive care.
- Future research should focus on large multinational prospective observational trials rather than randomized controlled trials, as organ dysfunction and treatment, not predisposition, significantly correlate with outcomes.
Unlabelled:
INTRODUCTION AND PURPOSE OF THE STUDY: With this study we aimed to describe a "true world" picture of severe paediatric 'community-acquired' septic shock and establish the feasibility of a future prospective trial on early goal-directed therapy in children. During a 6-month to 1-year retrospective screening period in 16 emergency departments (ED) in 12 different countries, all children with severe sepsis and signs of decreased perfusion were included.
Results:
A 270,461 paediatric ED consultations were screened, and 176 cases were identified. Significant comorbidity was present in 35.8 % of these cases. Intensive care admission was deemed necessary in 65.7 %, mechanical ventilation in 25.9 % and vasoactive medications in 42.9 %. The median amount of fluid given in the first 6 h was 30 ml/kg. The overall mortality in this sample was 4.5 %. Only 1.2 % of the survivors showed a substantial decrease in Paediatric Overall Performance Category (POPC). 'Severe' outcome (death or a decrease ≥2 in POPC) was significantly related (p < 0.01) to: any desaturation below 90 %, the amount of fluid given in the first 6 h, the need for and length of mechanical ventilation or vasoactive support, the use of dobutamine and a higher lactate or lower base excess but not to any variables of predisposition, infection or host response (as in the PIRO (Predisposition, Infection, Response, Organ dysfunction) concept).
Conclusion:
The outcome in our sample was very good. Many children received treatment early in their disease course, so avoiding subsequent intensive care. While certain variables predispose children to become septic and shocked, in our sample, only measures of organ dysfunction and concomitant treatment proved to be significantly related with outcome. We argue why future studies should rather be large multinational prospective observational trials and not necessarily randomised controlled trials.
