'Intermittent' versus 'continuous' ScvO2 monitoring in children with septic shock: a randomised, non-inferiority
Jhuma Sankar1, Man Singh2, Kiran Kumar2
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. jhumaji@gmail.com.
Insights
Continuous central venous oxygen saturation (ScvO2) monitoring in children with septic shock improved early shock resolution compared to intermittent monitoring. However, both methods showed similar outcomes for 24-hour shock resolution and mortality.
Area of Science:
- Pediatric Critical Care Medicine
- Septic Shock Management
- Hemodynamic Monitoring
Background:
- Septic shock in children requires timely and effective resuscitation.
- Central venous oxygen saturation (ScvO2) is a key indicator of tissue perfusion.
- The optimal method for monitoring ScvO2 in pediatric septic shock remains debated.
Purpose of the Study:
- To compare the efficacy of intermittent versus continuous ScvO2 monitoring.
- To assess the impact on shock resolution and mortality in pediatric septic shock.
- To determine the preferred monitoring strategy for initial resuscitation.
Main Methods:
- Randomized controlled trial involving children under 17 years with septic shock.
- Comparison of intermittent ScvO2 monitoring versus continuous ScvO2 monitoring groups.
- Management followed Surviving Sepsis Campaign Guidelines with ScvO2-guided resuscitation.
Main Results:
- Continuous monitoring showed a higher rate of shock resolution within the first 6 hours (36% vs. 19%).
- No significant difference was observed in shock resolution at 24 hours (69% vs. 63%).
- Mortality rates were similar between the intermittent and continuous monitoring groups (43% vs. 47%).
Conclusions:
- Continuous ScvO2 monitoring is preferred for titrating therapy in the initial hours of pediatric septic shock.
- Intermittent ScvO2 monitoring can be utilized if continuous monitoring is unavailable.
- Both methods demonstrated comparable long-term outcomes regarding shock resolution and mortality.
Purpose:
To compare the effect of 'intermittent' central venous oxygen saturation (ScvO2) monitoring with 'continuous' ScvO2 monitoring on shock resolution and mortality in children with septic shock.
Methods:
Primary outcome was the achievement of therapeutic goals or shock resolution in the first 6 h. We randomly assigned children < 17 years' age with septic shock to 'intermittent ScvO2' or 'continuous ScvO2' groups. All children were subjected to subclavian/internal jugular line insertion and managed as per Surviving Sepsis Campaign Guidelines. To guide resuscitation, we used ScvO2 estimated at other clinical and laboratory parameters were monitored similarly in both groups.
Results:
We enrolled 75 and 77 children [median (IQR) age: 6 (1.5-10) years] in the 'intermittent' and 'continuous' groups, respectively. Baseline characteristics were comparable between the groups. When compared to the 'continuous' group, fewer children in the 'intermittent' group achieved shock resolution within first 6 h [19% vs. 36%; relative risk (RR) 0.51; 95% CI 0.29-0.89; risk difference - 18.0%; 95% CI - 32.0 to - 4.0]. The lower bound of confidence interval, however, crossed the pre-specified non-inferiority margin. There was no difference in the proportion of children attaining shock resolution within 24 h (63% vs. 69%; RR 0.86; 95% CI 0.68-1.08) or risk of mortality between the groups (47% vs. 43%; RR 1.06; 95% CI 0.74-1.51).
Conclusions:
Given that a greater proportion of children attained therapeutic end points in the first 6 h, continuous monitoring of ScvO2 should preferably be used to titrate therapy in the first few hours in children with septic shock. In the absence of such facility, intermittent monitoring of ScvO2 can be used to titrate therapy in these children, given the lack of difference in the proportion of patients achieving shock resolution at 24 h or in risk of mortality between the intermittent and continuous groups.
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