Impact of early goal-directed therapy on morbidity and mortality of children with severe sepsis and septic shock / Impacto do tratamento precoce guiado por metas sobre a morbidade e mortalidade da sepse grave e do choque séptico em crianças
AUTOR(ES)
Claudio Flauzino de Oliveira
DATA DE PUBLICAÇÃO
2009
RESUMO
Introduction: ACCM/PALS guidelines address early correction of pediatric septic shock using conventional measures. In the evolution of these recommendations indirect measures of the balance between systemic oxygen delivery and demands using central venous or superior vena cava oxygen saturation (ScvO2 70%) in a goal directed approach have been added. However, while these additional goal-directed endpoints are based on evidenced based adult studies, the extrapolation to the pediatric patient remains unvalidated. Objective: The purpose of this study is to compare ACCM/PALS guidelines performed with and without ScvO2 goal-directed therapy on the morbidity and mortality rate of children with severe sepsis and septic shock. Methods: Children and adolescents with severe sepsis or fluid-refractory septic shock were randomly assigned to ACCM/PALS with, or without ScvO2 goal directed resuscitation. Twenty-eight day mortality was the primary endpoint. Results: Of the 102 enrolled patients, 51 received ACCM/PALS with ScvO2 goal directed therapy and 51 received ACCM/PALS without ScvO2 goal directed therapy. ScvO2 goal directed therapy resulted in less mortality (28-day 11.8 vs. 39.2 percent, p = 0.002), and fewer new organ dysfunctions (p = 0.03). ScvO2 goal directed therapy resulted in more crystalloid (28 [20-40] vs. 5 [0-20] mL/kg, p <0.0001), blood transfusion (45.1 vs. 15.7 percent, p = 0.002) and inotropic support (29.4 vs. 7.8 percent, p = 0.01) in the first 6 hours. Conclusions: This study supports the current ACCM/PALS guidelines. Goal directed therapy using the endpoint of a ScvO2 70% provides significant and additive impact on the outcome of children and adolescents with septic shock.
ASSUNTO(S)
septic shock crianças ressuscitação sepse children consumo de oxigênio débito cardíaco cardiac output choque séptico oxygen consumption resuscitation sepsis
Documentos Relacionados
- Impacto da terapia farmacológica de suporte nas variáveis hemodinâmica, de função renal e mortalidade de pacientes em sepse grave e choque séptico
- Clinical review: Goal-directed therapy in high risk surgical patients
- Goal-directed therapy in patients with early acute kidney injury: a multicenter randomized controlled trial
- Standard base excess e o nível sérico de lactato evolutivos nos pacientes com sepse grave e choque séptico reanimados com o early goal directed therapy: ainda discriminadores de mortalidade?
- Caracterização físico-química da acidose metabólica em pacientes com sepse grave ou choque séptico