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

Morin, Luc, Ray, Samiran, Wilson, Clare, Remy, Solenn, Benissa, Mohamed Rida, Jansen, Nicolaas J. G., Javouhey, Etienne, Peters, Mark J., Kneybar, Martin, De Luca, Daniele, Nadel, Simon, Schlapback, Luregn Jan, Maclaren, Graeme and Tissieres, Pierre (2016) Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition. Intensive Care Medicine, 42 12: 1-10. doi:10.1007/s00134-016-4574-2


Author Morin, Luc
Ray, Samiran
Wilson, Clare
Remy, Solenn
Benissa, Mohamed Rida
Jansen, Nicolaas J. G.
Javouhey, Etienne
Peters, Mark J.
Kneybar, Martin
De Luca, Daniele
Nadel, Simon
Schlapback, Luregn Jan
Maclaren, Graeme
Tissieres, Pierre
Title Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition
Journal name Intensive Care Medicine   Check publisher's open access policy
ISSN 1432-1238
0342-4642
Publication date 2016-10-05
Sub-type Article (original research)
DOI 10.1007/s00134-016-4574-2
Open Access Status DOI
Volume 42
Issue 12
Start page 1
End page 10
Total pages 10
Place of publication Heidelberg, 69121 Germany
Publisher Springer
Language eng
Abstract 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.
Formatted 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.
Keyword Shock
Septic
Paediatrics
Acidosis
Lactic
Resuscitation
Failure
Cardiac
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
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Created: Sat, 29 Oct 2016, 01:23:47 EST by Luregn Schlapbach Tribolet on behalf of Paediatrics & Child Health - Mater Hospital