Aims & Objectives:
To compare the effect of ‘intermittent’ central venous oxygen saturation (ScvO2) monitoring with ‘continuous’ ScvO2 monitoring on shock resolution and mortality in children with septic shock.
We randomly assigned children <17 years’ age with septic shock to ‘intermittent ScvO2’ or ‘continuous ScvO2’ groups. All children were subjected to subclavian/internal jugular line insertion and managed as per the Surviving Sepsis Campaign Guidelines. ScvO2 – estimated at 1, 3, 6, 12, 24, 48 and 72 hours in the ‘intermittent’ group and continuously using the central venous oximetry catheter in the ‘continuous’ group – was used to guide resuscitation; other clinical and laboratory parameters were monitored similarly in the two groups. Major outcomes were achievement of therapeutic goals within first 6 hours and in-hospital mortality. Data were analysed using STATA 13.
We enrolled 101 [62 boys; median (IQR) age: 6 (1.5 to 10) years] children: 50 and 51 in ‘intermittent’ and ‘continuous’ groups, respectively. Baseline characteristics including organ dysfunction and mortality risk scores were comparable between the groups. When compared to ‘intermittent’ group, more children in the ‘continuous’ group achieved therapeutic end points within first 6 hours (33% vs. 16%; RR 2.08, 95% CI 0.98 to 4.38) but there was no difference in mortality (43% vs. 46%; RR 1.06, 0.69 to1.64) between the groups.
Continuous ScvO2 monitoring resulted in higher proportion of children attaining therapeutic end points in the first 6 hours. However, this did not seem to affect the mortality. Larger studies are required to compare the effect on mortality.