DOI: 10.1097/CCM.0b013e31817c49c5
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Issn Print: 0090-3493
Publication Date: 2008/07/01
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Excerpt
We completely agree with Dr. Plötz that both short-term and long-term outcomes in survivors of meningococcal septic shock (MSS) are highly relevant. Only a few, unsystematic studies have been conducted in this field. These studies used small, heterogeneous patient samples, unstandardized assessment procedures, and focused mainly on short-term outcome. Therefore, our relatively large, homogeneous cohort offered the possibility to investigate the neglected area of outcome, both from a medical and psychosocial point of view, with standardized procedures. Parts of our outcome study have been published previously (2–5).
In his commentary, Dr. Plötz asked if we evaluated pulmonary or cardiac function in our cohort of MSS survivors. In our short-term follow-up study of MSS survivors requiring intensive care treatment between 2001 and 2005, pulmonary and cardiac functions were not tested specifically (2).
The second part of our study concerned a cross-sectional long-term outcome study of all 179 MSS survivors requiring intensive care treatment between 1988 and 2001 (3–5).
Of the 120 MSS survivors who visited the follow-up clinic, 46 required mechanical ventilation at the time of pediatric intensive care unit (PICU) admission. In six of these 46 patients, long-term lung function was performed because they had signs of acute respiratory distress syndrome (ARDS) at the time of MSS; novel presence of bilateral infiltrates on chest radiograph, Pao2/Fio2 <200 (median 53) (6). Duration of mechanical ventilation in these six ARDS patients was significantly longer (p < .001; 12.5 vs. 4 days) compared with the 40 patients without ARDS.
Other characteristics of the six ARDS patients at time of PICU admission; Pediatric Risk of Mortality 27, age at time of PICU admission 2 yrs, follow-up interval 11.3 yrs (all medians).
In all six, except one, flow volume curves were normal; forced vital capacity ranged from 100–123% predicted values (median 111) (unpublished data). One patient, with known asthma, had a normal forced vital capacity but showed signs of airways obstruction.
Plötz et al. also found normal lung function parameters in MSS survivors. However, they found desaturation (median 2.5%; range, 0–20%) during maximal exercise, whereas we did not measure this in our patients. None of our 120 MSS survivors reported exercise intolerance.
In the study by Plötz, the follow-up interval was shorter (3.4 yrs), and patients were older at time of PICU admission (4.7 yrs) compared with our study.
Several questions remain: does significant desaturation occur during maximal exercise long-term (as in our patients, >10 yrs) after MSS? If so, what is the cause? Could this be the result of lung fibrosis?
We are planning a long-term cardiac follow-study study in patients who survived fulminant MSS (high severity of illness scores) and who required high doses of inotropes/vasopressors. In this study, we will perform electrocardiograms and echocardiographic measurements.
In conclusion, we want to reassure Dr. Plötz that we did study long-term morbidity in MSS survivors.
The authors have not disclosed any potential conflicts of interest.
