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

  • Jhuma SankarEmail author
  • Man Singh
  • Kiran Kumar
  • M. Jeeva Sankar
  • Sushil Kumar Kabra
  • Rakesh Lodha
Pediatric Original

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.

Keywords

EGDT ScvO2 Intermittent ScvO2 monitoring Continuous ScvO2 monitoring 

Notes

Acknowledgements

We would like to sincerely thank the contributions of Dr Vijay and the staff of the PICU towards the conduct of the trial.

Funding

The authors received Intramural Research Grant (No.F. 8-335/A-335/2-15/RS) from All India Institute of Medical Sciences for this project (~ 7000 USD).

Compliance with ethical standards

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

134_2019_5858_MOESM1_ESM.docx (24 kb)
Supplementary material 1 (DOCX 23 kb)
134_2019_5858_MOESM2_ESM.docx (17 kb)
Supplementary material 2 (DOCX 16 kb)
134_2019_5858_MOESM3_ESM.docx (62 kb)
Supplementary material 3 (DOCX 62 kb)

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Copyright information

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

Authors and Affiliations

  1. 1.Department of PediatricsAll India Institute of Medical SciencesNew DelhiIndia

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