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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

Pediatric Critical Care Medicine: June 2013 - Volume 14 - Issue 5 - p 462–466
doi: 10.1097/PCC.0b013e31828a7287
Feature Articles

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.

1Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.

2Department of Pediatrics, McMaster University, Ottawa, ON, Canada.

3Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.

4Department of Epidemiology and Community Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.

5Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH.

*See also p. 541.

This work was performed at the Children’s Hospital of Eastern Ontario.

Dr. McNally is an academic pediatric intensivist paid to provide clinical service and engage in scholarly activity, including research. Dr. Choong received grant support from CIHR. Dr. Ward receives payment for writing and reviewing the manuscript/preparation: Children's Hospital of Eastern Ontario Research Institute—paid salary for role as Critical Care Clinical Research Manager. Dr. Wong receives grant support from NIH and payment for lectures from SCCM. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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