Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Kuellinger, B.
Improvement of septic shock management in children in the last 20 years: A retrospective study
Humanmedizin; [ Diplomarbeit ] Medical University of Graz; 2021. pp. 69
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Marschitz Ingrid Christine
- Roedl Siegfried
- Altmetrics:
- Abstract:
- Background: Septic shock is still a common cause of death in pediatric intensive care units (PICUs). However, most research is conducted among adult patients and therefore, mortality and morbidity among them have decreased over the last years. Since there are some major differences to children, guidelines provided for management of septic shock in adults only have limited applicability in children. The aim of this study is to provide an overview on how treatment of septic shock in children has changed over the last 20 years and to point out potential future improvements. Methods: In this retrospective, explorative study, 22 patients with septic shock administered to PICU between 2000 and 2019 were included. In order to compare them, they were split into two groups, depending on their date of admission. Primary outcomes investigated were hospital mortality and PICU length of stay. Various secondary outcomes were evaluated as well, including the medication these patients received. Differences in treatment and outcome between both groups were explored as well as correlation of administration of certain drugs and outcome. Results: Whilst mortality rate was 58,3% in the first group, it accounted for 20% in the second group. Neither did they differ significantly in regard of mortality rate nor PICU length of stay. Most therapy administered did not show alterations between the two groups. Management mainly varied in type of catecholamine used for circulatory support as well as number and types of antibiotics given. Administration of norepinephrine also was strongly associated with survival and longer PICU length of stay. Conclusion: Observed changes in septic shock management showed some improvement of outcome, even though it could not be proven. The observed main reasons for this development were a switch from nonselective catecholamines with potential adverse effects (dopamine, epinephrine) towards a more selective and physiological cardiovascular support with norepinephrine on the one hand and antibiotic combination treatment and more frequent adjustment of the antibiotic therapy on the other hand.