Evaluation of Early Corticosteroid Therapy in Management of Pediatric Septic Shock in Pediatric Intensive Care Patients: A Randomized Clinical Study

BACKGROUND:: Septic shock is a major healthcare problem. Adrenal insufficiency in children with septic shock is a recognized complication, yet is controversial regarding its management and effect on mortality. According to the current guidelines, children with risk factors for adrenal insufficiency should receive a stress dose of steroids in step 3 of treatment. This study aimed to evaluate and compare early corticosteroid therapy with the traditional use of steroids among pediatric septic shock patients. METHODS:: This prospective randomized interventional clinical study included 3 groups of patients (32 each) and was conducted in Alexandria University PICU. By protocol the first group received steroids in step 3 of the treatment according to the current international guidelines (group A)and the second group was managed as group A and was tested for adrenal insufficiency (AI) by adrenal stimulation test using intramuscular ACTH (Cosyntropin) (group B). The third group received steroids at the start of fluid therapy (group C). A 4th group (D), was created by adding patients from group A and B who needed corticosteroids in the third stage of therapy according to the international protocol in one group. All patients were evaluated for basal serum cortisol and plasma ACTH concentrations. RESULTS:: The data showed a statistically significant shorter shock reversal time among patients receiving corticosteroids at the start of treatment compared with those who received it at the 3rd step of treatment (P= 0.046); however, mortality was not statistically different among the groups. Additionally, there was no superinfection in cases receiving early steroid therapy. CONCLUSION:: Early use of corticosteroid in patients with septic shock might shorten the shock reversal time without increase in mortality or super-infection.