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Randomized Controlled Trial
. 2025 Mar 31;7(4):e1242.
doi: 10.1097/CCE.0000000000001242. eCollection 2025 Apr 1.

Electrocardiometry for the Management of Pediatric Septic Shock: A Pilot Randomized Controlled Trial

Suman Sudha Moharana  1 , Lalitha Av  2 , Santu Ghosh  3
Affiliations
Randomized Controlled Trial

Electrocardiometry for the Management of Pediatric Septic Shock: A Pilot Randomized Controlled Trial

Suman Sudha Moharana et al. Crit Care Explor. .

Abstract

Objectives: To evaluate the difference in the resuscitation fluid volume in the initial 6 hours in pediatric septic shock between those undergoing noninvasive continuous hemodynamic monitoring with electrocardiometry in addition to clinical monitoring vs. clinical monitoring alone.

Design: Randomized control trial.

Setting: PICU in a tertiary care hospital.

Patients: Children from 2 months to 18 years with sepsis and unresolved shock after the initial fluid bolus (FB).

Interventions: Children were randomized to one of the two groups, that is, electrocardiometry with clinical monitoring group (group B) and clinical monitoring alone group (group A). In group B, electrocardiometry variables (cardiac index and systemic vascular resistance index) along with clinical monitoring were used to guide FB, as well as selection and titration of vasoactive agents. Clinical parameters were used to initiate and titrate fluid resuscitation and vasoactive therapy in group A as per standard guidelines.

Measurements and main results: One hundred nineteen children were enrolled in the study: 60 in group A and 59 in group B. There was a significantly higher requirement for resuscitation fluid volume (mean ± sd) within the initial 6 hours in the group A (30 ± 8.2 mL/kg) as compared with group B (22 ± 9.2 mL/kg). Similarly, maintenance along with resuscitation fluid volume (mean ± sd) administration (56 ±13 vs. 46 ±10.7, p < 0.001) was higher in group A in the first 24 hours of enrollment. Vasoactive therapy initiation was earlier in group B as compared with group A (37 ± 10.14 vs. 47.33 ± 12.41 min) with lower fluid overload percentage (2.98% vs. 1.7%) in this group. However, there was no difference in time to shock resolution, 28-day ICU-free days, hospital-free days, and mortality.

Conclusions: Advanced hemodynamic monitoring with electrocardiometry along with clinical assessment led to a restrictive fluid strategy in addition to minimizing the risk of fluid overload.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Consort flow chart. CHD = congenital heart diseases, CKD = chronic kidney disease, SAM = severe acute malnutrition.
Figure 2.
Figure 2.
Resuscitation fluid volume requirement in initial 6 hr.
See this image and copyright information in PMC

References

    1. Weiss SL, Fitzgerald JC, Pappachan J, et al. ; Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network: Global epidemiology of pediatric severe sepsis: The sepsis prevalence, outcomes, and therapies study. Am J Respir Crit Care Med 2015; 191:1147–1157 - PMC - PubMed
    1. Sankar J, Sankar MJ, Suresh CP, et al. : Early goal-directed therapy in pediatric septic shock: Comparison of outcomes “with” and “without” intermittent superior venacaval oxygen saturation monitoring. Pediatr Crit Care Med 2014; 15:e157–e167 - PubMed
    1. Oliveira CF, Nogueira De Sá FR, Oliveira DSF, et al. : Time- and fluid-sensitive resuscitation for hemodynamic support of hildren in septic shock: Barriers to the implementation of the American College of Critical Care Medicine/Pediatric Advanced Life Support guidelines in a pediatric intensive care unit in a developing world. Pediatr Emerg Care 2008; 24:810–815 - PubMed
    1. Maitland K, Kiguli S, Opoka RO, et al. ; FEAST Trial Group: Mortality after fluid bolus in African children with severe infection. N Engl J Med 2011; 364:2483–2495 - PubMed
    1. Gupta D, Dhingra S: Electrocardiometry fluid responsiveness in pediatric septic shock. Indian J Crit Care Med 2021; 25:123–125 - PMC - PubMed

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