Citation Information :
Uppala R, Samransamruajkit R, Prapphal N, Sritippayawan S, Pongsanon K, Deelodejanawong J. Clinical outcomes after utilizing surviving sepsis campaign in children with septic shock and prognostic value of initial plasma NT-proBNP. Indian J Crit Care Med 2014; 18 (2):70-76.
Background and Objective: The surviving sepsis campaign treatment guideline (SSC) implementation is associated with improved outcome in adults with severe sepsis. The effect on outcome of pediatric sepsis is less clear. Purpose : To determine the clinical outcomes of SSC implementation and to investigate the prognostic value of initial plasma NT-proBNP and procalcitonin in children. Materials and Methods: Infants and children (aged 1month/0-15 years with severe sepsis or septic shock) were prospectively enrolled and treated according to the guidelines. Initial blood drawn was saved for NT-pro-BNP, procalcitonin measurements and clinical data were also recorded. Results: A total of 47 subjects were recruited. Since the application of the SSC, our mortality rate had significantly decreased from 42-19% (P = 0.003) as compared to the data in the previous 3 years. Clinical factors that significantly increased the mortality rate were: Initial central venous oxygen saturation < 7 0% after fluid resuscitation [odds ratio (OR) = 23.3; 95% confidence interval (CI) 3.7-143; P = 0.001], and initial albumin level (≤ 3 g/dl, OR = 6.7; 95% CI 1.2-37.5, P = 0.03). There was asignificant difference between the initial NT-proBNP levels between survivors and non survivors, (6280.3 ± 9597 ng/L, P < 0.001), but not for procalcitonin (12.7 ± 24.8, 29.3 ± 46 μg/L, P = 0.1), respectively. An initial NT-proBNP level of more than 11,200 pg/ml predicted Pediatric Intensive Care Unit (PICU) mortality with a sensitivity of 85.7% and a specificity of 90%. Conclusions: A modified SSC for severe sepsis and septic shock significantly reduced the mortality rate in our PICU. High initial NT-ProBNP level was associated with mortality.
Kissoon N, Argent A, Devictor D, Madden MA, Singhi S, van der Voort E, et al. World federation of pediatric intensive and critical care societies-its global agenda. Pediatr Crit Care Med 2009;10:597-600.
Oliveira C, Nogueira F, Oliveira D, Gottschald AF, Moura JD, Shibata AR, et al. Time-and fluid sensitive resuscitation for hemodynamic support of children in septic shock: Barriers to the implementation of the American College of Critical Care Medicine/Pediatric Advanced Life Support Guidelines in a pediatric intensive care unit in a developing world. Pediatr Emerg Care 2008;24:810-5.
Wolfer A, Silvani P, Musicco M, Antonelli M, Salvo I, Italian Pediatric Sepsis Study (SISPe) group. Incidence of and mortality due to sepsis, severe sepsis and septic shock in Italian Pediatric Intensive Care units: A prospective national survey. Intensive Care Med 2008;34:1690-7.
Samransamruajkit R, Hiranrat T, Prapphal N, Sritippayawan S, Deerojanawong J, Poovorawan Y. Levels of protein C activity and clinical factors in early phase of pediatric septic shock may be associated with the risk of death. Shock 2007;28:518-23.
Carcillo JA, Fields A, American College of Critical Care Medicine Task Force Committee Members. Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 2002;30:1365-78.
Han Y, Carcillo JA, Dragotta M, Bills DM, Watson RS, Westerman ME, et al. Early reversal of Pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics 2003;112:793-9.
Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, et al. Surviving Sepsis Campaign Management Guidelines Committee. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32:858-73.
Kissoon N, Carcillo JA, Espinosa V, Argent A, Devictor D, Madden M, et al. Global Sepsis Initiative Vanguard Center Contributors. World Federation of Pediatric Intensive Care and Critical Care Societies: Global Sepsis Initiative. Pediatr Crit Care Med 2011;12:494-503.
Pronovost P, Berenholtz S, Ngo K, McDowell M, Holzmueller C, Haraden C, et al. Developing and testing quality indicators in the intensive care unit. J Crit Care 2003;18:145-55.
Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related blood stream infections in the ICU. N Engl J Med 2006;355:2725-32.
Goldstein B, Giroir BP, Randolph A. International consensus conference on pediatric sepsis. International consensus on pediatric sepsis. Pediatr Crit Care Med 2005;6:2-8.
Brierley J, Carcillo JA, Choong K, Cornell T, Decaen A, Deymann A, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: Update from American College of Critical Care Medicine. Crit Care Med 2009;37:666-88.
Rivers EP, Nguyen HB, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early Goal-Directed Therapy Collaborative Group. Early goal directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;346:1368-77.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303-10.
Shiramizo S, Marra A, Durao M, Paes ÂT, Edmond MB, Pavão dos Santos OF. Decreasing mortality in severe sepsis and septic shock patients by implementing a sepsis bundle in a hospital setting. PLoS One 2011;6:e26790.
Ferrer R, Artigas A, Suarez D, Palencia E, Levy MM, Arenzana A, et al. Edusepsis Study Group. Effectiveness of treatments for severe sepsis: A prospective, multicenter, observational study. Am J Respir Crit Care Med 2009;180:861-6.
Baronchia A, CUI X, Vitberg D, Suffredini AF, O′Grady NP, Banks SM, et al. Bundled Care for septic shock: An Analysis of clinical trials. Crit Care Med 2010;38:668-78.
Marshall JC, Al Naqbi A. Principles of source control in the management of sepsis. Crit Care Nurs Clin North Am 2011;23:99-114.
Bochud PY, Bonten M, Marchetti O, Calandra T. Antimicrobial therapy for patients with severe sepsis and septic shock: An evidence-based review. Crit Care Med 2004;32 Suppl 11:S495-512.
Cohen J, Brun-Buisson C, Torres A, Jorgensen J. Diagnosis of infection in sepsis: An evidence-based review. Crit Care Med 2004;32 Suppl 11 :S466-94.
Gao F, Melody T, Daniels DF, Giles S, Fox S. The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: A prospective observational study. Crit Care 2005;9:R764-70.
Na S, Kuan WS, Mahadevan M, Li CH, Shrikhande P, Ray S, et al. Atlas Investigators. Implementation of early goal-directed therapy and the surviving sepsis campaign resuscitation bundle in Asia. Int J Qual Health Care 2012;24:452-62.
Phua J, Koh Y, Du B, Tang YQ, Divatia JV, Tan CC, et al. Mosaics Study Group. Management of severe sepsis in patients admitted to Asian intensive care units: Prospective cohort study. BMJ 2011;342:d3245.
Giuliano KK. Physiological monitoring for critically ill patients: Testing a predictive model for the early detection of sepsis. Am J Crit Care 2007;16:122-30.
Robson WP. From A and E to ICU: How nurses can support the Surviving Sepsis Campaign. Intensive Crit Care Nurs 2004;20:113-5.
Slade E, Tamber PS, Vincent JL. The Surviving Sepsis Campaign: Raising awareness to reduce mortality. Crit Care 2003;7:1-2.
Peake S, Bailey M, Bellomo R, Cameron PA, Cross A, Delaney A, et al. ARISE Investigators, for the Australian and New Zealand Intensive Care Society Clinical Trials Group. Australasian resuscitation of sepsis evaluation (ARISE): A multicenter, prospective, inception cohort study. Resuscitation 2009;80:811-8.
van Beest PA, Hofstra JJ, Schultz MJ, Boerma EC, Spronk PE, Kuiper MA. The incidence of low venous oxygen saturation on admission to the intensive care unit: A multi-center observational study in The Netherlands. Crit Care 2008;12:R33.
Castellanos-Ortega A, Suberviola B, Garcia-Astudillo LA, Holanda MS, Ortiz F, Llorca J, et al. Impact of the Surviving Sepsis Campaign protocols on hospital length of stay and mortality in septic shock patients: Results of a three-year follow-up quasi-experimental study. Crit Care Med 2010;38:1036-43.
de Oliveira LT, De Oliveira DS, Gottschald A, Moura J, Costa G, Ventura A, et al. ACCM/PALS hemodynamic support guidelines for pediatric septic shock: An outcome comparison with and without monitoring central venous oxygen saturation. Intensive Care Med 2008;34:1065-75.
Kopterides P, Siampos I, Tsangaris I, Tsantes A, Armaganidis A. Procalcitonin-guided algorithms of antibiotic therapy in the Intensive care unit: A systematic review and Meta-analysis of randomized controlled trials. Crit Care Med 2010;38:2229-41.
Reinhart K, Carlet JM. Procalcitonin-A new marker of severe infection and sepsis. Intensive Care Med 2000;26 Suppl 2:S145.
Ceneviva G, Paschall J, Maffei F, Carcillo JA. Hemodynamic support in fluid-refractory pediatric septic shock. Pediatrics 1998;102:e19.
Parker MM, Hazelzet JA, Carcillo JA. Septic shock: Pediatric considerations. Crit Care Med 2004;32 Suppl 11:591-S4.
Brueckmann M, Huhle G, Lang S, Haase KK, Bertsch T, Weiss C, et al. Prognostic value of plasma N-terminal pro-brain natriuretic peptide in patients with severe sepsis. Circulation 2005;112:527-34.
Roch A. What does high NT-ProBNP mean in septic shock patients? A part of the puzzle. Crit Care 2007;11:122.
Zhang Z, Zhang Zhen, Xue Y, Xu X, Ni H. Prognostic value of B-type natriuretic peptide (BNP) and its potential role in guiding fluid therapy in critically ill septic patients. Scan J Trauma Resusc Emerg Med 2012;20:86.
Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. Fluid resuscitation in septic shock: A positive fluid balance and elevated CVP are associated with increased mortality. Crit Care Med 2011;39:259-65.