Paediatric community-acquired septic shock: results from the REPEM network study

• DOI: 10.1007/s00431-013-1930-x
• Publication Date: 2013-01-25T03:12:36Z
• Authors: P. Van de Voorde; B. Emerson; B. Gomez; J. Willems; D. Yildizdas; I. Iglowstein; E. Kerkhof; N. Mullen; C. R. Pinto; T. Detaille; N. Qureshi; J. Naud; J. De Dooy; R. Van Lancker; A. Dupont; N. Boelsma; M. Mor; D. Walker; M. Sabbe; S. Hachimi-Idrissi; L. Da Dalt; H. Waisman; D. Biarent; I. Maconochie; H. Moll; J. Benito
• Keywords: Organ dysfunction; Dobutamine

INTRODUCTION AND PURPOSE OF THE STUDY: With this study we aimed to describe a "true world" picture of severe paediatric 'community-acquired' septic shock and establish the feasibility future prospective trial on early goal-directed therapy in children. During 6-month 1-year retrospective screening period 16 emergency departments (ED) 12 different countries, all children with sepsis signs decreased perfusion were included.A 270,461 ED consultations screened, 176 cases identified. Significant comorbidity was present 35.8 % these cases. Intensive care admission deemed necessary 65.7 %, mechanical ventilation 25.9 vasoactive medications 42.9 %. The median amount fluid given first 6 h 30 ml/kg. overall mortality sample 4.5 Only 1.2 survivors showed substantial decrease Paediatric Overall Performance Category (POPC). 'Severe' outcome (death or ≥2 POPC) significantly related (p < 0.01) to: any desaturation below 90 h, need for length support, use dobutamine higher lactate lower base excess but not variables predisposition, infection host response (as PIRO (Predisposition, Infection, Response, Organ dysfunction) concept).The our very good. Many received treatment their disease course, so avoiding subsequent intensive care. While certain predispose become shocked, sample, only measures organ dysfunction concomitant proved be outcome. We argue why studies should rather large multinational observational trials necessarily randomised controlled trials.