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. 2020 Jan;46(1):82-92.
doi: 10.1007/s00134-019-05858-w. Epub 2019 Nov 28.

'Intermittent' versus 'continuous' ScvO2 monitoring in children with septic shock: a randomised, non-inferiority trial

Jhuma Sankar  1 , Man Singh  2 , Kiran Kumar  2 , M Jeeva Sankar  2 , Sushil Kumar Kabra  2 , Rakesh Lodha  2
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'Intermittent' versus 'continuous' ScvO2 monitoring in children with septic shock: a randomised, non-inferiority trial

Jhuma Sankar et al. Intensive Care Med. 2020 Jan.

Abstract

Purpose: To compare the effect of 'intermittent' central venous oxygen saturation (ScvO2) monitoring with 'continuous' ScvO2 monitoring on shock resolution and mortality in children with septic shock.

Methods: Primary outcome was the achievement of therapeutic goals or shock resolution in the first 6 h. We randomly assigned children < 17 years' age with septic shock to 'intermittent ScvO2' or 'continuous ScvO2' groups. All children were subjected to subclavian/internal jugular line insertion and managed as per Surviving Sepsis Campaign Guidelines. To guide resuscitation, we used ScvO2 estimated at other clinical and laboratory parameters were monitored similarly in both groups.

Results: We enrolled 75 and 77 children [median (IQR) age: 6 (1.5-10) years] in the 'intermittent' and 'continuous' groups, respectively. Baseline characteristics were comparable between the groups. When compared to the 'continuous' group, fewer children in the 'intermittent' group achieved shock resolution within first 6 h [19% vs. 36%; relative risk (RR) 0.51; 95% CI 0.29-0.89; risk difference - 18.0%; 95% CI - 32.0 to - 4.0]. The lower bound of confidence interval, however, crossed the pre-specified non-inferiority margin. There was no difference in the proportion of children attaining shock resolution within 24 h (63% vs. 69%; RR 0.86; 95% CI 0.68-1.08) or risk of mortality between the groups (47% vs. 43%; RR 1.06; 95% CI 0.74-1.51).

Conclusions: Given that a greater proportion of children attained therapeutic end points in the first 6 h, continuous monitoring of ScvO2 should preferably be used to titrate therapy in the first few hours in children with septic shock. In the absence of such facility, intermittent monitoring of ScvO2 can be used to titrate therapy in these children, given the lack of difference in the proportion of patients achieving shock resolution at 24 h or in risk of mortality between the intermittent and continuous groups.

Keywords: Continuous ScvO2 monitoring; EGDT; Intermittent ScvO2 monitoring; ScvO2.

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References

    1. Jaramillo-Bustamante JC, Marín-Agudelo A, Fernández-Laverde M, Bareño-Silva J (2012) Epidemiology of sepsis in pediatric intensive care units: first Colombian multicenter study. Pediatr Crit Care Med 13:501–508 - DOI
    1. Sankar J, Dhochak N, Kumar K, Singh M, Sankar MJ, Lodha R (2019) Comparison of international pediatric sepsis consensus conference versus sepsis-3 definitions for children presenting with septic shock to a tertiary care center in India: a retrospective study. Pediatr Crit Care Med 20:e122–e129 - DOI
    1. Hartman ME, Linde-Zwirble WT, Angus DC, Watson RS (2013) Trends in the epidemiology of pediatric severe sepsis. Pediatr Crit Care Med 14:686–693 - DOI
    1. Weiss SL, Fitzgerald JC, Pappachan J et al (2017) Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resource Evaluation (CORE) and Australian and New Zealand Intensive Care Society (ANZICS) Paediatric Study Group. Prediction of pediatric sepsis mortality within 1 h of intensive care admission. Prediction of pediatric sepsis mortality within 1 h of intensive care admission. Intensiv Care Med 43:1085–1096 - DOI
    1. Wiens MO, Larson CP, Kumbakumba E et al (2016) Application of Sepsis definitions to pediatric patients admitted with suspected infections in uganda. Pediatr Crit Care Med 17:400–405 - DOI

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