‘Intermittent’ versus ‘continuous’ $ ScvO_{2} $ monitoring in children with septic shock: a randomised, non-inferiority trial

Purpose To compare the effect of ‘intermittent’ central venous oxygen saturation ($ ScvO_{2} $) monitoring with ‘continuous’ $ ScvO_{2} $ 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 $ ScvO_{2} $’ or ‘continuous $ ScvO_{2} $’ groups. All children were subjected to subclavian/internal jugular line insertion and managed as per Surviving Sepsis Campaign Guidelines. To guide resuscitation, we used $ ScvO_{2} $ 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 $ ScvO_{2} $ 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 $ ScvO_{2} $ 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..

Medienart:	E-Artikel

Erscheinungsjahr:	2019
Erschienen:	2019

Enthalten in:	Zur Gesamtaufnahme - volume:46
Enthalten in:	Intensive care medicine - 46(2019), 1 vom: 28. Nov., Seite 82-92

Sprache:	Englisch

Beteiligte Personen:	Sankar, Jhuma [VerfasserIn] Singh, Man [VerfasserIn] Kumar, Kiran [VerfasserIn] Sankar, M. Jeeva [VerfasserIn] Kabra, Sushil Kumar [VerfasserIn] Lodha, Rakesh [VerfasserIn]

Links:	Volltext [lizenzpflichtig]

Themen:	Continuous ScvO EGDT Intermittent ScvO Monitoring ScvO

Anmerkungen:	© Springer-Verlag GmbH Germany, part of Springer Nature 2019

doi:	10.1007/s00134-019-05858-w

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	SPR001248634