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Intensive Care Medicine

, Volume 34, Issue 6, pp 1065–1075 | Cite as

ACCM/PALS haemodynamic support guidelines for paediatric septic shock: an outcomes comparison with and without monitoring central venous oxygen saturation

  • Cláudio F. de OliveiraEmail author
  • Débora S. F. de Oliveira
  • Adriana F. C. Gottschald
  • Juliana D. G. Moura
  • Graziela A. Costa
  • Andréa C. Ventura
  • José Carlos Fernandes
  • Flávio A. C. Vaz
  • Joseph A. Carcillo
  • Emanuel P. Rivers
  • Eduardo J. Troster
Pediatric Original

Abstract

Introduction

The ACCM/PALS guidelines address early correction of paediatric 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 evidence-based adult studies, the extrapolation to the paediatric patient remains unvalidated.

Objective

The purpose of this study was to compare treatment according to 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.

Design, participants and interventions

Children and adolescents with severe sepsis or fluid-refractory septic shock were randomly assigned to ACCM/PALS with or without ScvO2 goal-directed resuscitation.

Measurements

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 mortality 11.8% vs. 39.2%, 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%, p = 0.002) and inotropic (29.4% vs. 7.8%, p = 0.01) support in the first 6 h.

Conclusions

This study supports the current ACCM/PALS guidelines. Goal-directed therapy using the endpoint of a ScvO2 ≥ 70% has a significant and additive impact on the outcome of children and adolescents with septic shock.

Keywords

Child Sepsis Resuscitation Central venous oxygen saturation Cardiac output Goal-directed therapy 

Notes

Acknowledgements

We are indebted to the nursing and medical staff of the intensive care units; to Professor Claudio Leone, for statistical advice; and to Dr. Crésio Romeu Pereira, for assistance with study design.

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Cláudio F. de Oliveira
    • 1
    • 5
    Email author
  • Débora S. F. de Oliveira
    • 1
  • Adriana F. C. Gottschald
    • 1
  • Juliana D. G. Moura
    • 1
  • Graziela A. Costa
    • 1
  • Andréa C. Ventura
    • 2
  • José Carlos Fernandes
    • 2
  • Flávio A. C. Vaz
    • 1
  • Joseph A. Carcillo
    • 3
  • Emanuel P. Rivers
    • 4
  • Eduardo J. Troster
    • 1
  1. 1.Paediatric Intensive Care Unit, Department of PaediatricsInstituto da Criança Pedro de Alcântra da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
  2. 2.Paediatric Intensive Care UnitHospital Universitário da Universidade de São PauloSão PauloBrazil
  3. 3.Department of Critical Care MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA
  4. 4.Departments of Emergency Medicine and SurgeryHenry Ford Health SystemsDetroitUSA
  5. 5.São PauloBrazil

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