Author Of 1 Presentation
RANDOMIZED COMPARISON OF EARLY GOAL-DIRECTED THERAPY (EGDT) WITH INTERMITTENT SCVO2 VS. STANDARD CARE IN PEDIATRIC SEPTIC SHOCK MANAGEMENT IN RESOURCE LIMITED SETTING.
Abstract
Background
Significant differences in processes of care in septic shock exist between the developed and developing region. Despite advances in the understanding of septic shock, mortality is 20% in developed and 50% in the resource limited setting.
Objectives
The primary endpoint is 28-day all-cause mortality. Secondary endpoints are therapeutic endpoint achieved, new onset organ failure and length of PICU and hospital stay.
Methods
TThe open-labeled randomized controlled trial enrolled the 120 children aged one-month to 12-year with septic shock. Patients were randomized to EGDT with intermittent ScvO2 monitoring (n=59) and standard care with no ScvO2 monitoring (n=61) group. EGDT group patient was managed by modified Rivers et al. protocol (intermittent ScvO2 instead of continuous monitoring). Standard care group patient managed by protocol adapted from adapted from Rivers et al.
Results
EGDT-group had lower mortality (35.6%) as compared to standard care-group (60.6%; RR=0.61, 95%CI 0.42–0.88, p=0.006). Dobutamine need in first six-hour (61.1% vs. 33.9%; p=0.004) and PRBC need (59% vs. 23%; p=0.056) was higher in the EGDT-group. There was no difference in therapeutic endpoint achieved at six-hour (61.1% vs. 57.1%; p=0.672), at 72-hour median (IQR) SOFA-score (4, 1–9 vs. 6, 2–11), PeLOD-score (6, 1–14 vs. 10, 2–17) and median stay in PICU (5, 3–9 vs. 5, 2–10 days) and in hospital (8, 5–13 vs. 7, 5–13 days).
Conclusion
EGDT with intermittent ScvO2 monitoring was associated with lower all-cause 28-day mortality in pediatric septic shock in resource limited setting as compared to standard care.