Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2008 Jun;34(6):1065-75.
doi: 10.1007/s00134-008-1085-9. Epub 2008 Mar 28.

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

Cláudio F de Oliveira  1 , 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
Affiliations
Randomized Controlled Trial

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

Cláudio F de Oliveira et al. Intensive Care Med. 2008 Jun.

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 (ScvO(2) > or = 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 ScvO(2) 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 ScvO(2) goal-directed resuscitation.

Measurements: Twenty-eight-day mortality was the primary endpoint.

Results: Of the 102 enrolled patients, 51 received ACCM/PALS with ScvO(2) goal-directed therapy and 51 received ACCM/PALS without ScvO(2) goal-directed therapy. ScvO(2) 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). ScvO(2) 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 ScvO(2)> or =70% has a significant and additive impact on the outcome of children and adolescents with septic shock.

Trial registration: ClinicalTrials.gov NCT00407823.

PubMed Disclaimer

Comment in

  • Back to basics in septic shock.
    Peters MJ, Brierley J. Peters MJ, et al. Intensive Care Med. 2008 Jun;34(6):991-3. doi: 10.1007/s00134-008-1086-8. Epub 2008 Mar 28. Intensive Care Med. 2008. PMID: 18369590 No abstract available.

References

    1. Pediatr Nephrol. 2005 Aug;20(8):1177-81 - PubMed
    1. Circulation. 1969 Aug;40(2):165-72 - PubMed
    1. Crit Care Med. 2001 Jul;29(7):1303-10 - PubMed
    1. Chest. 1993 Mar;103(3):900-6 - PubMed
    1. Intensive Care Med. 1989;15(4):228-32 - PubMed

Publication types

Associated data