儿科

儿童液体或血管扩张性休克使用激素治疗的流行病学

作者:刘爽 编译 来源:医学论坛网 日期:2015-03-29
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Pediatric Critical Care Medicine:

May 2014 - Volume 15 - Issue 4_suppl - p 60

doi: 10.1097/01.pcc.0000448981.00175.08

THE EPIDEMIOLOGY OF STEROID USE IN CHILDREN WITH FLUID OR VASOACTIVE INFUSION DEPENDANT SHOCK

Menon, K.; McNally, D.; Lawson, M.; Choong, K.; Ramsay, T.; Wong, H.

ABSTRACT

Background and aims: Severe shock may rapidly progress to multi-organ failure and death. Despite the lack of conclusive evidence for benefit and the potential for harm, pediatric intensive care physicians continue to report using steroids to treat this condition.

Aims: We therefore sought to better understand the epidemiology of steroid use in this patient population.

Methods: We conducted a one year, retrospective study of all patients with shock admitted to one of four Canadian PICUs in 2011. This study was approved by the IRB which waived the need for informed consent.

Results: 364 patients were enrolled. Patients who received steroids had higher PRISM scores (13 vs 9, P< 0.0001) and were more likely to have received > 60 ml/kg of fluid (50.8% vs 32.9%, P=0.0008). Steroids were more likely to be used in patients with sepsis (50/94; P < 0.0001) and respiratory diseases (14/26; P = 0.05). There was an increase in the number of vasoactive agents used (2 vs 1; P = 0.0054) and the amount of fluid received (18.2 vs 9.0 ml; P = 0.0027) with steroid use after correcting for illness severity. There was no difference in the incidence of gastrointestinal bleeding, use of insulin infusions or positive cultures observed with the use of steroids.

Conclusions: Clinicians commonly use steroids in children with fluid or vasoactive infusion dependant shock and these children appear to have worse outcomes but no increase in adverse events. A randomized controlled trial is necessary to determine the true effect of steroids on outcomes in pediatric shock.

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