Main Article Content
Background Septic shock remains a major cause of morbidity and mortality in children admitted to the intensive care unit. Recent investigations from developed countries have reported mortality rates of 20-30%. Few studies have reported mortality rates from pediatric septic shock in intensive care settings in developing countries with limited resources.
Objective To determine the current mortality rates for pediatric patients with septic shock in a developing country.
Methods A retrospective study was conducted in the Pediatric Intensive Care Unit (PICU) at DR. Sardjito General Hospital. Medical records and charts were reviewed and recorded for diagnoses of septic shock, from November 1st, 2011 to June 30th, 2014.
Results A database of all PICU admissions was assembled, and cases with diagnoses of septic shock were reviewed. The final data consisted of 136 patients diagnosed with septic shock. Septic shock was defined as a clinical suspicion of sepsis, manifested by hyperthermia or hypothermia, and accompanied by hypoperfusion The overall mortality rate for the study cohort was 88.2%. The median age of patients was 16 months, with 52.2% males. Median initial PRISM III and PELOD scores were 10 and 22, respectively. The median length of PICU stay was 4 days. A total of 48.5% of the subjects were in need of crystalloid and colloid fluid at a median amount of 40 mL/kg. The median time required to complete the initial resuscitation was 60 minutes. Mechanical ventilator support in the first 24 hours was required in 79.4% of the cases. Fluid overload of > 10% (FO>10%) was found in 58.8% of the subjects.
Conclusion The mortality rate in pediatric septic shock in our hospital is very high. There is a higher incidence of fluid overload in the non-survival group .
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
2. Arikan AA, Citak A. Pediatric shock. Signa Vitae. 2008;3:13-23.
3. Fisher JD, Nelson DG, Beyersdorf H, Satkowiak LJ. Clinical spectrum of shock in the pediatric emergency department. Pediatr Emerg Care. 2010;26:622-5.
4. Singh D, Chopra A, Pooni PA, Bhatia RC. A clinical profile of shock in children in Punjab India. Indian Pediatr. 2006;43:619-25.
5. Wheeler DS, Basu RK. Pediatric shock: an overview. Open Pediatr Med J. 2013; 7:2-9.
6. Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatric. Pediatr Crit Care Med. 2005;6:2-8.
7. Kutko MC, Calarco MP, Flaherty MB, Helmrich RF, Ushay HM, Pon S, et al. Mortality rates in pediatric septic shock with and without multiple organ system failure. Pediatr Crit Care. 2003;4:333-7.
8. Pollack MM, Fields AI, Ruttimann UE. Sequential cardiopulmonary variables of infants and children in septic shock. Crit Care Med. 1984;12:554-9.
9. Bierley 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: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009;37:666-688.
10. Carcillo JA, Han K, Lin J, Orr R. Goal-directed management of pediatric shock in the emergency department. Clin Pediatr Emerg Med. 2007;8:165-75.
11. Goldstein SL, Currier H, Graf CD, Cosio CF, Brewer ED, Sachdeva R. Outcome in children receiving continuous venovenous hemofiltration. Pediatrics. 2001;107:1309-12.
12. Kaur G, Vinayak N, Mittal K, Kaushik JY, Aamir M. Clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock from Rohtak, Haryana: a prospective observational study. Indian J Crit Care Med. 2014;18:437-41.
13. Gillespie RS, Seidel K, Symons JM. Effect of fluid overload and dose of replacement fluid on survival in hemofiltration. Pediatr Nephrol. 2004;19:1394-9.
14. Foland JA, Fortenberry JD, Warshaw BL, Pettigano R, Merritt RK, Heard ML, et al. Fluid overload before continous hemofiltration and survival in critically ill children: a retrospective analysis. Crit Care Med. 2004;32:1771-6.
15. Arikan A, Zappitelli M, Goldstein SL, Naipaul A, Jefferson LS, Loftis LL. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. Pediatr Crit Care Med. 2012;13:253-8.
16. Micek ST, McEvoy C, McKenzie M, Hampton N, Doherty JA, Kollef MH. Fluid balance and cardiac function in septic shock as predictors of hospital mortality. Crit Care. 2013;17:R246.