Pediatric Critical Care Medicine:
Abstracts of the 7th World Congress on Pediatric Critical Care
1Pediatrics, St. John’s Medical College Hospital, Bangalore, India
Background and aims: The role of corticosteroid therapy in septic shock is ill defined.
Aims: To determine the impact of adjunctive corticosteroid therapy on the outcome of children with catecholamine resistant septic shock.
Methods: Children (1 month – 18 years age) with catecholamine resistant septic shock were recruited during the study period between July 2012-December 2012. Children with low cortisol levels received hydrocortisone therapy as per septic shock guidelines. The outcome of these children were compared to the group with normal cortisol levels.
Results: 60 out of 100 children with septic shock were catecholamine resistant. The proportion of children with low cortisol levels was 23/60 (38.3%). The demographic profile of the 2 goups were comparable in terms of median age in years (2(IQR 0.9,6) vs 3(IQR0.8,8)), gender ratio (M:F:: 0.8:1 vs 1:1) and median PRISM III Score [10(IQR 7,15) vs 15(IQR 8,20), p=0.17)]. Hydrocortisone therapy in the low cortisol level group improved survival as compared to the group with normal cortisol levels (52.2% vs 24.3%, p < 0.02). However, length of PICU stay [6 (IQR2,8) vs 4 (IQR 2,8)], hospital stay [8 (IQR 2,11.5) vs 4 (IQR 2,10)] in days, inotrope duration [84 (IQR 36,144) vs 72 (IQR 36,168)] and ventilation duration [84 (IQR 48,144) vs 72 (IQR 48,120)] in hours was not statistically significant (p>0.05).
Conclusions: Our data strongly supports the use of hydrocortisone for catecholamine resistant septic shock. However, randomised control trials with larger sample size are warranted to define its role in the management of pediatric septic shock.