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Hemodynamic monitoring in sepsis and septic shock in pediatric patients: a multicenter survey
Carolina Barone Quintella Cury1, Daniela Carla de Souza2, Orlei Ribeiro de Araujo3
1Postgraduate Program in Child and Maternal Health - Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brazil.
Insights
Brazilian pediatric intensive care units show varied hemodynamic monitoring practices for sepsis, differing from international guidelines. Understanding these differences is key for improving care in resource-limited settings.
Area of Science:
- Pediatric Critical Care Medicine
- Hemodynamic Monitoring
- Sepsis Management
Background:
- Current hemodynamic monitoring practices in pediatric sepsis and septic shock vary globally.
- International guidelines exist but their adoption in resource-limited settings like Brazil remains unclear.
Purpose of the Study:
- To assess current hemodynamic monitoring strategies for pediatric sepsis and septic shock in Brazilian pediatric intensive care units.
- To identify discrepancies between established guidelines and actual clinical practice.
Main Methods:
- A multicenter, cross-sectional study was conducted.
- An electronic survey was distributed to 77 pediatric intensive care units across 26 Brazilian states.
Main Results:
- Point-of-care cardiac ultrasound is used for fluid responsiveness in 61% of units.
- Invasive arterial blood pressure monitoring is not universally applied, with 57% using it for all septic shock patients.
- Clinical assessment guides 70% of vasoactive agent decisions, while lactate trends are monitored in 88%.
Conclusions:
- Significant differences exist between international hemodynamic monitoring guidelines and practices in Brazilian pediatric intensive care units.
- These practice variations highlight the need to adapt guidelines for feasibility in low- and middle-income countries.
- Recognizing these differences is crucial for optimizing pediatric sepsis management.
Objective:
To evaluate the current practices of hemodynamic monitoring in sepsis and septic shock in Brazilian pediatric intensive care units.
Methods:
A multicenter, cross-sectional study using an electronic survey.
Results:
An electronic survey was responded to in three rounds (1 week each), and responses from 77 pediatric intensive care units in 26 states of Brazil were collected. Point-of-care cardiac ultrasound was the method of choice for fluid responsiveness evaluation in septic children in 61% pediatric intensive care units; 78% pediatric intensive care units had enough arterial line monitors available to every bed, but only 57% use invasive arterial blood pressure monitoring for every patient diagnosed with septic shock; 22% use invasive arterial blood pressure monitoring just for refractory shock patients. To guide initiation/titration of inotropes and vasoactive agents, 70% pediatric intensive care units said their decision is based on clinical assessment; 20% use point-of-care cardiac ultrasound to aid vasoactive agent choice; 88% pediatric intensive care units use Lactate trend, and 35% measure central/mixed venous saturation in patients with septic shock.
Conclusion:
Differences between international guidelines and practice in Brazilian pediatric intensive care units regarding hemodynamic monitoring in pediatric sepsis were identified. These differences may arise for several reasons; recognizing them is crucial to making appropriate changes and adjusting valuable guidelines to make them more feasible for low- and middle-income countries.
