PURPOSE: Septic shock is a major cause of morbidity and mortality among children admitted to PICU. This study was to determine the common medications and fluid resuscitation in early phase of septic shock admitted to our PICU.
METHODS: We restrospective reviewed medical records from 2003-2008 and enrolled the patients who diagnosed to have septic shock within 72 hrs of PICU admission.
RESULTS: Approximately 2400 patients were admitted to our PICU during the study peroid. There were 66 (1.5%) patients enrolled to the study. There were 38 (57.6%) male and 28 (42.4%) female. The average age was at 5.9±4.8 years. The most common types of Initial fluids resuscitation were combined both crystalloids and colloids (45/66, 68%). Only crystalloids was used in 18 (27%) and only colloids in 3 (4.5%). Those who received crystalloids together with colloids including PRC and FFP had a significant risk of mortality compared to other group (P=0.01). Dopamine (63, 95%) was the most common inotrope used in the study followed with Dobutamine 44 (66.6%), Adrenaline 26(39%), Noredrenaline in 22 (33%) and Milrinone in 4(6%). Those who received adrenaline had significant risk of mortality (OR = 3.6, P=.015, CI: 2.6- 10.7) Targeting SVC sat ≥ 70% was not commonly used. Most common initial antibiotics administered was Carbapenem group 27 (40.9%), Vancomycin 21 (31.8%), Cefotaxime 17 (25.8%) and Ceftazidime 17 (25.8%). Carbapenem combined with Vancomycin were utilized in 8 (12%). Corticosteroids was utilized in 26 (39%) with different dosing and duration. Only 5(6%) patients were given IVIG. The mortality was at 45% (30/66).
CONCLUSION: The mortality of children with septic shock is high despite advance in technology. Management of septic shock in our Instituition was varied widely among individuals and mostly did not follow SSC guidelines.
CLINICAL IMPLICATIONS: The basic knowledge of common medications and fluid resuscitation in this high risk group will lead us to improve our outcome by developing protocolized septic shock management based on SSC guideline.
DISCLOSURE: Rujipat Samransamruajkit, No Financial Disclosure Information; No Product/Research Disclosure Information