第五百分比与第50百分比的平均血压目标在儿科的败血症休克:一个随机对照试验
Sachin Shah1, Amita Kaul, Ganesh Shiwarkar
1All authors: Neonatal and Pediatric Intensive Care Services, Surya Mother and Child Superspecialty Hospital, Pune, Maharashtra, India.
Critical care medicine
|June 13, 2025
概括
在儿科败血症休克中准较低的平均血压 (MBP) 百分位数并没有增加28天死亡率. 这种方法可以安全地减少危急儿童的血管活性剂使用和相关不良事件.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 儿科重症监护室的重症监护人员.
- 败血栓冲击管理管理
背景情况:
- 低血压在儿科败血症休克中很常见,需要以平均血压 (MBP) 为指导的血管活性剂定位.
- 目前的指导方针缺乏关于儿科败血症休克中血管活性剂定位的最佳MBP目标 (第5个百分位与第50个百分位) 的共识.
研究的目的:
- 为了比较向第5个和第50个MBP百分位的血管活性剂定位在患有败血性休克的儿童中的有效性和安全性.
主要方法:
- 一个单中心,开放标签,随机的非劣等性试验在印度的三级护理儿科重症监护室 (PICU) 中进行.
- 1个月至16岁的144名患有无液体反应的败血症,需要血管压缩剂的儿童被随机分配到第5或第50个MBP百分位目标组.
- 调整了血管压缩剂治疗以保持分配的MBP目标,以28天所有原因的死亡率为主要结局.
主要成果:
- 在第5百分位组 (16.9%) 和第50百分位组 (23.2%) (p = 0.41) 之间没有观察到28天全因死亡率的显著差异.
- 第50个百分位组需要更高的诺亚上腺素使用 (85%vs67%),更长的血管活性剂持续时间 (30.4vs18.8天),并且急性呼吸困扰综合征 (ARDS) 的患病率更高 (32.8%vs16.9%).
- 没有发现PICU/住院时间,通风持续时间,需要持续置换疗法 (CRRT) 或血管压缩剂相关不良事件的显著差异.
结论:
- 在儿科败血症休克中准较低的MBP (第5百分位数) 与准较高的MBP (第50百分位数) 在28天死亡率方面不逊色.
- 较低的MBP目标可能是一个安全的策略,可能减少血管活性药物需求和相关并发症,如ARDS.
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