Evaluation of Early Corticosteroid Therapy in Management of Pediatric Septic Shock in Pediatric Intensive Care Patients

A Randomized Clinical Study

Ahmed El-Nawawy, Doaa Khater, Heba Omar, Yasser Wali

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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.

Original languageEnglish
JournalPediatric Infectious Disease Journal
DOIs
Publication statusAccepted/In press - Oct 25 2016

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Critical Care
Septic Shock
Secondary Prevention
Adrenal Cortex Hormones
Pediatrics
Adrenal Insufficiency
Steroids
Adrenocorticotropic Hormone
Mortality
Shock
Guidelines
Cosyntropin
Therapeutics
Superinfection
Fluid Therapy
Hydrocortisone
Clinical Studies
Delivery of Health Care
Infection
Serum

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

Cite this

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title = "Evaluation of Early Corticosteroid Therapy in Management of Pediatric Septic Shock in Pediatric Intensive Care Patients: A Randomized Clinical Study",
abstract = "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.",
author = "Ahmed El-Nawawy and Doaa Khater and Heba Omar and Yasser Wali",
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T1 - Evaluation of Early Corticosteroid Therapy in Management of Pediatric Septic Shock in Pediatric Intensive Care Patients

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AU - El-Nawawy, Ahmed

AU - Khater, Doaa

AU - Omar, Heba

AU - Wali, Yasser

PY - 2016/10/25

Y1 - 2016/10/25

N2 - 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.

AB - 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.

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