Evaluating the effectiveness of fluid resuscitation on hemodynamic parameters of paediatric patients with septic shock

Dien Tran Minh, Thang Pham Van

ABSTRACT

Septic shock is not a common but a severe and highly fatal disease. International paediatric sepsis consensus conference 2002 (IPSCC 2002) gave recommendations for early recognition of shock, fluid resuscitation and using vasoactive drugs which were effective in reducing mortality of septic shock in children.

Objectives

To evaluate the effectiveness of fluid resuscitation on hemodynamic parameters of pediatric patients with septic shock.

Methods

Quasiexperimental study designs. One hundred and two patients, aged from 1 month to 15 years old with septic shock, admitted to the pediatric intensive care unit of the National Hospital of Pediatrics from January, 2005 to December, 2007. We used the IPSCC 2002 guideline for the management of sep- tic shock. Patients were divided in three groups: Group I: fluid-resistant, dopamine-responsive shock; Group II: fluid-resistant, dopamine-resistant shock; and Group III: Catecholamine-resistant shock. Pre- and post fluid resuscitation hemodynamic parameters such as heart rate, mean blood pressure, central venous pressure (CVP) were compared in the first hour.

Results

Mean fluid volume was 44.6 ± 24.49 ml/kg in the first hour, crystalloid fluid accounted for 88.2%. Normalized systolic blood pressure was increased from 11.8% to 34.3% after fluid bolus (p < 0.0001). Tachycardia was decreased from 77.5% to 56.5% after fluid bolus (p = 0.0002). CVP increased from 4.1± 3.12 cm H2O (n = 35) to 7.9 ± 3.20 cm H2O (n = 71) after fluid bolus. Pulmonary edema was noted in 7.84%. After 1 hour, mortality rate was higher in the group with higher CVP >10 cm H2O (p=0.03). Mean fluid bolus volume was lower in non-survived group (p=0.013).

Conclusion

Mean fluid volume for resuscitation in the first stage was 40-60 ml/kg. Fluid bolus improved blood pressure, heart rate. Nonsurvivors had lower fluid resuscitation volume and higher CVP.

Keywords:

Septic shock, fluid resuscitation in the first stage

PHIẾU ĐẶT MUA TẠP CHÍ
THÔNG TIN QUẢNG CÁO
Bo y te
Cục KHCN & ĐT
Đại học y hà nội
Đại học Dược HN

Copyright 2012 TẠP CHÍ Y DƯỢC HỌC VIỆT NAM XUẤT BẢN BẰNG TIẾNG ANH

Giấy phép số 2477/GP-BTTTT ngày 19/12/2012.

Tổng biên tập: PGS.TS Nguyễn Thị Kim Tiến - Bộ trưởng Bộ Y tế

Văn phòng Tạp chí: P611 A1 Đại học Y Hà Nội; Số 1 - Tôn Thất Tùng - Đống Đa - Hà Nội.      

Điện thoại: (04) 3574 7782; 0915704995 (đ/c Nguyên)        Email: info@vjmp.vn        Website: vjmp.vn



THỐNG KÊ TRUY CẬP

Đang trực tuyến : 37
Tổng truy cập : 270,473