臨床小児科: オープンアクセス
オープンアクセス
ISSN: 2572-0775
ISSN: 2572-0775
Siripen Sanguanngam, Lalida Kongkiattikul, Rujipat Samransamruajkit*
Background: Several studies have shown that positive fluid balance is associated with worse outcomes in pediatric severe sepsis and septic shock patients. Early vasopressor administration in children with septic shock after ≤ 40 cc/kg of fluid bolus may be beneficial.
Methods: This is a retrospective analytic study in children with septic shock (aged between one month and 18 years from 2012-2020.) They were recruited at a referral tertiary university hospital in Bangkok, Thailand and were treated with either restricted volume resuscitation (≤ 40 cc/kg of fluid bolus) combined with vasopressors or standard volume resuscitation. The clinical effect on fluid balance and other outcomes were measured.
Results: One hundred and forty three patients were diagnosed with septic shock. Ninety three patients started vasoactive agents at ≤ 40 mL/kg (study group) compared to 50 patients who started the vasopressor drugs after 40 mL/kg of fluid bolus (control group). Volume administered at 6 hours, 24 hours and 48 hours in study group was significantly less than control group (p<0.001). There was a trend of higher %Fluid Overload (%FO) at 24 hours to 72 hours in control group but it was not statistically significant. %FO at 24 hours was significantly correlated with time initiation of vasoactive agent (R2=0.17, p=0.03) and length of PICU stay (R2=0.2, p=0.02). In addition, the multivariate analysis showed that initial serum level of albumin was less than 3 g/dL and positive %FO of more than 10% at 24 hours significantly increased mortality by 6.3 (95% CI, 1.25 to 32.12; p=0.03) and 6.1 folds (95% CI, 1.47 to 25.46; p=0.01), respectively.
Conclusion: There was a trend of decreasing %FO overtime in study group compared to the control group. Time initiation of vasoactive agent and %FO significantly correlated with prolonged PICU stay.