Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 1/2020

01-01-2020 | Shock | Pediatric Original

‘Intermittent’ versus ‘continuous’ ScvO2 monitoring in children with septic shock: a randomised, non-inferiority trial

Authors: Jhuma Sankar, Man Singh, Kiran Kumar, M. Jeeva Sankar, Sushil Kumar Kabra, Rakesh Lodha

Published in: Intensive Care Medicine | Issue 1/2020

Login to get access

Abstract

Purpose

To compare the effect of ‘intermittent’ central venous oxygen saturation (ScvO2) monitoring with ‘continuous’ ScvO2 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 ScvO2’ or ‘continuous ScvO2’ groups. All children were subjected to subclavian/internal jugular line insertion and managed as per Surviving Sepsis Campaign Guidelines. To guide resuscitation, we used ScvO2 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 ScvO2 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 ScvO2 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.
Appendix
Available only for authorised users
Literature
1.
Jaramillo-Bustamante JC, Marín-Agudelo A, Fernández-Laverde M, Bareño-Silva J (2012) Epidemiology of sepsis in pediatric intensive care units: first Colombian multicenter study. Pediatr Crit Care Med 13:501–508CrossRef
2.
Sankar J, Dhochak N, Kumar K, Singh M, Sankar MJ, Lodha R (2019) Comparison of international pediatric sepsis consensus conference versus sepsis-3 definitions for children presenting with septic shock to a tertiary care center in India: a retrospective study. Pediatr Crit Care Med 20:e122–e129CrossRef
3.
Hartman ME, Linde-Zwirble WT, Angus DC, Watson RS (2013) Trends in the epidemiology of pediatric severe sepsis. Pediatr Crit Care Med 14:686–693CrossRef
4.
Weiss SL, Fitzgerald JC, Pappachan J et al (2017) Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resource Evaluation (CORE) and Australian and New Zealand Intensive Care Society (ANZICS) Paediatric Study Group. Prediction of pediatric sepsis mortality within 1 h of intensive care admission. Prediction of pediatric sepsis mortality within 1 h of intensive care admission. Intensiv Care Med 43:1085–1096CrossRef
5.
Wiens MO, Larson CP, Kumbakumba E et al (2016) Application of Sepsis definitions to pediatric patients admitted with suspected infections in uganda. Pediatr Crit Care Med 17:400–405CrossRef
6.
Rivers E, Nguyen B, Havstad S et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377CrossRef
7.
Focht A, Jones AE, Lowe TJ (2009) Early goal-directed therapy: improving mortality and morbidity of sepsis in the emergency department. Jt Comm J Qual Patient Saf 35:186–191CrossRef
8.
Chelkeba L, Ahmadi A, Abdollahi M, Najafi A, Mojtahedzadeh M (2015) Early goal-directed therapy reduces mortality in adult patients with severe sepsis and septic shock: systematic review and meta-analysis. Indian J Crit Care Med 19:401–411CrossRef
9.
Davis AL, Carcillo JA, Aneja RK et al (2017) American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med 45:1061–1093CrossRef
10.
Liu B, Ding X, Yang J (2016) Effect of early goal directed therapy in the treatment of severe sepsis and/or septic shock. Curr Med Res Opin 32:1773–1782CrossRef
11.
ARISE Investigators; ANZICS Clinical Trials Group (2014) Goal-directed resuscitation for patients with early septic shock. N Engl J Med 371:1496–1506CrossRef
12.
Investigators ProCESS, Yealy DM, Kellum JA, Huang DT et al (2014) A randomized trial of protocol-based care for early septic shock. N Engl J Med 370:1683–1693CrossRef
13.
Mouncey PR, Osborn TM, Power GS, ProMISe Trial Investigators et al (2015) Trial of early, goal-directed resuscitation for septic shock. N Engl J Med 372:1301–1311CrossRef
14.
de Oliveira CF, de Oliveira DS, Gottschald AF et al (2008) ACCM/PALS haemodynamic support guidelines for paediatric septic shock: an outcomes comparison with and without monitoring central venous oxygen saturation. Intensiv Care Med 34:1065–1075CrossRef
15.
Sankar J, Sankar MJ, Suresh CP, Sankar MJ, Dubey N (2014) Early goal-directed therapy in pediatric septic shock: comparison of outcomes “with” and “without” intermittent superior venacaval oxygen saturation monitoring: a prospective cohort study. Pediatr Crit Care Med 15:e157–e167CrossRef
16.
Gross PA (2006) Hypotension and mortality in septic shock: the “golden hour”. Crit Care Med 34:1819–1820CrossRef
17.
Han YY, Carcillo JA, Dragotta MA, Bills DM, Watson RS, Westerman ME, Orr RA (2003) Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics 112:793–799CrossRef
18.
Huh JW, Oh BJ, Lim CM, Hong SB, Koh Y (2013) Comparison of clinical outcomes between intermittent and continuous monitoring of central venous oxygen saturation (ScvO2) in patients with severe sepsis and septic shock: a pilot study. Emerg Med J 30:906–909CrossRef
19.
Paula IRN, Timothy WS, Steven QS (2009) Effect of intermittent vs continuous scvo2 monitoring on sepsis bundle compliance and mortality. October 2009, Vol 136, No. 4 MeetingAbstracts
20.
Goldstein B, Giroir B, Randolph A (2005) International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensiv Crit Care Soc 6: 2–8
21.
Haque IU, Zaritsky AL (2007) Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children. Pediatr Crit Care Med 8:138–144CrossRef
22.
Dellinger RP, Levy MM, Rhodes A et al (2012) Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensiv Care Med 39:165–228CrossRef
23.
Carcillo JA, Fields A (2002) Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. J Pediatr (Rio J) 78:449–466CrossRef
24.
Pediatric Advanced Life Support Provider Manual, Chameides L, Samson RA, Schexnayder SM, Hazinski MF (Eds) (2012) American Heart Association, Dallas
25.
Perner A, Haase N, Wiis J, White JO, Delaney A (2010) Central venous oxygen saturation for the diagnosis of low cardiac output in septic shock patients. Acta Anaesthesiol Scand 54:98–102CrossRef
26.
Walley KR (2011) Use of central venous oxygen saturation to guide therapy. Am J Respir Crit Care Med 184:514–520CrossRef
27.
Ding XF, Yang ZY, Xu ZT et al (2018) Early goal-directed and lactate-guided therapy in adult patients with severe sepsis and septic shock: a meta-analysis of randomized controlled trials. J Transl Med 16:331CrossRef
Metadata
Title
‘Intermittent’ versus ‘continuous’ ScvO2 monitoring in children with septic shock: a randomised, non-inferiority trial
Authors
Jhuma Sankar
Man Singh
Kiran Kumar
M. Jeeva Sankar
Sushil Kumar Kabra
Rakesh Lodha
Publication date
01-01-2020
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 1/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-019-05858-w

Other articles of this Issue 1/2020

Intensive Care Medicine 1/2020 Go to the issue

Less is more in Intensive Care

‘Less is more’ in modern ICU: blessings and traps of treatment limitation

Letter

Disordered swallowing associated with prolonged oral endotracheal intubation in critical illness

Original

Do-not-intubate orders in patients with acute respiratory failure: a systematic review and meta-analysis

Correspondence

Distinction between good palliative care and intending death

Letter

Characterization and validation of a novel measure of septic shock severity

Original

Conservative oxygen therapy for mechanically ventilated adults with sepsis: a post hoc analysis of data from the intensive care unit randomized trial comparing two approaches to oxygen therapy (ICU-ROX)