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Open Access 01-12-2016 | Pediatric Original

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

Authors: Luc Morin, Samiran Ray, Clare Wilson, Solenn Remy, Mohamed Rida Benissa, Nicolaas J. G. Jansen, Etienne Javouhey, Mark J. Peters, Martin Kneyber, Daniele De Luca, Simon Nadel, Luregn Jan Schlapbach, Graeme Maclaren, Pierre Tissieres, ESPNIC Refractory Septic Shock Definition Taskforce the Infection Systemic Inflammation Sepsis section of ESPNIC

Published in: Intensive Care Medicine | Issue 12/2016

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.

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Title: Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition
Authors: Luc Morin
Samiran Ray
Clare Wilson
Solenn Remy
Mohamed Rida Benissa
Nicolaas J. G. Jansen
Etienne Javouhey
Mark J. Peters
Martin Kneyber
Daniele De Luca
Simon Nadel
Luregn Jan Schlapbach
Graeme Maclaren
Pierre Tissieres
ESPNIC Refractory Septic Shock Definition Taskforce the Infection Systemic Inflammation Sepsis section of ESPNIC
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 12/2016
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-016-4574-2

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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