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Observational Study
. 2016 Dec;42(12):1948-1957.
doi: 10.1007/s00134-016-4574-2. Epub 2016 Oct 5.

Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition

Luc Morin  1 , Samiran Ray  2 , Clare Wilson  3 , Solenn Remy  4 , Mohamed Rida Benissa  1 , Nicolaas J G Jansen  5 , Etienne Javouhey  4 , Mark J Peters  2 , Martin Kneyber  6   7 , Daniele De Luca  8 , Simon Nadel  3 , Luregn Jan Schlapbach  9   10   11 , Graeme Maclaren  12   13 , Pierre Tissieres  14   15 ; ESPNIC Refractory Septic Shock Definition Taskforce the Infection Systemic Inflammation Sepsis section of ESPNIC
Affiliations
Observational Study

Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition

Luc Morin et al. Intensive Care Med. 2016 Dec.

Abstract

Purpose: Although overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and neonatal intensive care (ESPNIC) experts' definition of paediatric RSS.

Methods: We conducted a two-round Delphi study followed by an observational multicentre retrospective study. One hundred and fourteen paediatric intensivists answered a clinical case-based, two-round Delphi survey, identifying clinical items consistent with RSS. Multivariate analysis of these items in a development single-centre cohort (70 patients, 30 % mortality) facilitated development of RSS definitions based on either a bedside or computed severity score. Both scores were subsequently tested in a validation cohort (six centres, 424 patients, 11.6 % mortality).

Results: From the Delphi process, the draft definition included evidence of myocardial dysfunction and high blood lactate levels despite high vasopressor treatment. When assessed in the development population, each item was independently associated with the need for extracorporeal life support (ECLS) or death. Resultant bedside and computed septic shock scores had high discriminative power against the need for ECLS or death, with areas under the receiver operating characteristics curve of 0.920 (95 % CI 0.89-0.94), and 0.956 (95 % CI 0.93-0.97), respectively. RSS defined by a bedside score equal to or higher than 2 and a computed score equal to or higher than 3.5 was associated with a significant increase in mortality.

Conclusions: This ESPNIC definition of RSS accurately identifies children with the most severe form of septic shock.

Keywords: Acidosis; Cardiac; Failure; Lactic; Paediatrics; Resuscitation; Septic; Shock.

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Conflict of interest statement

Compliance with ethical standards Funding None. Conflicts of interest Dr. Javouhey reports grants from CSL Behring, personal fees from Gambro-Baxter, outside the submitted work. Dr. Tissieres reports grants from Merieux Foundation, non-financial support from Chiesi Inc, outside the submitted work. All other authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart of the validation cohort
Fig. 2
Fig. 2
Receiver operating characteristics curves for the computed septic shock score (cSSS) and the bedside septic shock score (bSSS). Area under the ROC curve in the validation population was 0.956 (95 % CI = 0.93–0.97, p < 0.01) for the cSSS and 0.920 (95 % CI = 0.89–0.94, p < 0.01) for the bSSS
Fig. 3
Fig. 3
Survival curve of refractory septic shock defined by a a bedside septic shock score ≥2.5, and b a computed septic shock score ≥3.5
See this image and copyright information in PMC

References

    1. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C, Black RE. Child health epidemiology reference group of WHO and UNICEF global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379:2151–2161. doi: 10.1016/S0140-6736(12)60560-1. - DOI - PubMed
    1. Schlapbach LJ, Straney L, Alexander J, MacLaren G, Festa M, Schibler A, Slater A, ANZICS Paediatric Study Group Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002–13: a multicentre retrospective cohort study. Lancet Infect Dis. 2015;15:46–54. doi: 10.1016/S1473-3099(14)71003-5. - DOI - PubMed
    1. Watson RS, Carcillo JA, Linde-Zwirble WT, Clermont G, Lidicker J, Angus DC. The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med. 2003;167:695–701. doi: 10.1164/rccm.200207-682OC. - DOI - PubMed
    1. Kaukonen K-M, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014;311:1308–1316. doi: 10.1001/jama.2014.2637. - DOI - PubMed
    1. Bone RC, Fisher CJ, Clemmer TP, Slotman GJ, Metz CA, Balk RA. Sepsis syndrome: a valid clinical entity. Methylprednisolone Severe Sepsis Study Group. Crit Care Med. 1989;17:389–393. doi: 10.1097/00003246-198905000-00002. - DOI - PubMed

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