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Resuscitation Bundle in Pediatric Shock Decreases Acute Kidney Injury and Improves Outcomes

Ayse Akcan Arikan1, Eric A Williams2, Jeanine M Graf2

  • 1Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX; Section of Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX.

The Journal of Pediatrics
|September 29, 2015
PubMed

Insights

Implementing a septic shock protocol in the pediatric emergency department significantly reduced acute kidney injury (AKI) and mortality. This early resuscitation strategy also shortened hospital stays for critically ill children.

Area of Science:

  • Pediatric Critical Care Medicine
  • Nephrology
  • Emergency Medicine

Background:

  • Acute kidney injury (AKI) is a common complication in pediatric sepsis.
  • Early recognition and management of septic shock are crucial for improving outcomes.

Purpose of the Study:

  • To evaluate the impact of an early emergency department (ED) septic shock protocol (SSP) on the incidence of AKI in pediatric patients.
  • To assess the effect of the SSP on renal replacement therapy, length of stay, and mortality.

Main Methods:

  • Retrospective cohort study of pediatric patients with clinical sepsis admitted to the pediatric intensive care unit (PICU) from the ED.
  • Comparison of outcomes before (PRE) and after (POST) implementation of the SSP.
  • AKI defined by pRIFLE criteria.

Main Results:

  • The POST group showed a significant decrease in AKI incidence (54% vs 29%, P < .001).
  • The SSP was associated with reduced need for renal-replacement therapy (4 vs 0, P = .04), shorter PICU and hospital lengths of stay (LOS), and lower mortality (10% vs 3%, P = .037).
  • Multivariate analyses confirmed the SSP's independent association with decreased AKI and shorter LOS.

Conclusions:

  • Protocol-driven resuscitation in the pediatric ED effectively reduces AKI and renal-replacement therapy requirements.
  • Implementation of the SSP leads to improved outcomes, including decreased LOS and mortality in pediatric sepsis.
Abstract

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