Early Goal-Directed Therapy in Pediatric Septic Shock: Comparison of Outcomes “With” and “Without” Intermittent Superior Venacaval Oxygen Saturation Monitoring

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Abstract

Objective:

To evaluate the effect of intermittent central venous oxygen saturation monitoring (ScvO2) on critical outcomes in children with septic shock, as continuous monitoring may not be feasible in most resource-restricted settings.

Design:

Prospective cohort study.

Setting:

PICU of a tertiary care teaching hospital.

Patients:

Consecutive children younger than 17 years with fluid refractory septic shock admitted to our ICU from November 2010 to October 2012 were included.

Interventions:

Enrolled children were subjected to subclavian/internal jugular catheter insertion. Those in whom it was successful formed the “exposed” group (ScvO2 group), whereas the rest constituted the control group (no ScvO2 group). In the former group, intermittent ScvO2 monitoring at 1, 3, and 6 hours was used to guide resuscitation, whereas in the latter, only clinical variables were used.

Measurements and Main Results:

The major outcomes were in-hospital mortality and achievement of therapeutic goals within first 6 hours. One hundred twenty children were enrolled in the study–63 in the ScvO2 group and 57 in the no ScvO2 group. Baseline characteristics including the organ dysfunction and mortality risk scores were comparable between the groups. Children in the ScvO2 group had significantly lower in-hospital mortality (33.3% vs 54%; relative risk, 0.61; 95% CI, 0.4, 0.93; number needed to treat, 5; 95% CI, 3, 27). A greater proportion of children in exposed group achieved therapeutic endpoints in first 6 hours (43% vs 23%, p = 0.02) and during entire ICU stay (71% vs 51%, p = 0.02). The mean number of dysfunctional organs was also significantly lesser in ScvO2 group in comparison with no ScvO2 group (2 vs 3, p < 0.001).

Conclusion:

Early goal-directed therapy using intermittent ScvO2 monitoring seemed to reduce the mortality rates and improved organ dysfunction in children with septic shock as compared with those without such monitoring.

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