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Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0b013e31828a7287
Feature Articles

A Survey of Stated Physician Practices and Beliefs on the Use of Steroids in Pediatric Fluid and/or Vasoactive Infusion-Dependent Shock*

Menon, Kusum MD, MSc, FRCPC1; McNally, James D. MD, PhD, FRCPC1; Choong, Karen MB, MSc, FRCPC2; Ward, Roxanne E. BA3; Lawson, Margaret L. MD, MSc, FRCPC1; Ramsay, Tim MSc, PhD4; Wong, Hector R. MD5

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Abstract

Objective: Limited evidence exists on the use of corticosteroids in pediatric shock. We sought to determine physicians’ practices and beliefs with regard to the management of pediatric shock.

Design: Cross-sectional, Internet-based survey.

Setting: Canada.

Subjects: Physicians identified as practicing pediatric intensive care in any of 15 academic centers.

Measurements and Main Results: Seventy of 97 physicians (72.2%) responded. Physicians stated that they were more likely to prescribe steroids for septic shock than for shock following cardiac surgery (odds ratio, 1.9 [95% CI, 0.9–4.3]) or trauma (odds ratio, 11.46 [95% CI, 2.5–51.2]), and 91.4% (64/70) would administer steroids to patients who had received 60 cc/kg of fluid and two or more vasoactive medications. Thirty-five percent of respondents (25/70) reported that they rarely or never conducted adrenal axis testing before giving steroids to patients in shock. Eighty-seven percent of respondents (61/70) stated that the role of steroids in the treatment of fluid and/or vasoactive drug-dependent shock needed to be clarified and that 84.3% would be willing to randomize patients into a trial of steroid efficacy who were fluid resuscitated and on one high-dose vasoactive medication. However, 74.3% stated that they would start open-label steroids in patients who required two high-dose vasoactive medications.

Conclusions: This survey provides information on the stated beliefs and practices of pediatric critical care physicians with regard to the use of steroids in fluid and/or vasoactive drug-dependent shock. Clinicians feel that the role of steroids in shock still requires clarification and that they would be willing to randomize patients into a trial. This survey may be useful as an initial framework for the development of a future trial on the use of steroids in pediatric shock.

©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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