Safety and usefulness of invasive arterial blood pressure monitoring in purpura fulminans resuscitation.
BACKGROUND
Invasive blood pressure (BP) monitoring (IBPM) is recommended in the treatment of fluid-refractory septic shock, but has been suspected of inducing distal ischemia in children with purpura fulminans (PF). The aim of the study was to determine if IBPM increases the risk of limb and skin necrosis and alters outcome of children with PF.


METHODS
Children admitted with PF and suspected meningococcal sepsis to two PICUs were retrospectively studied. BP was invasively monitored in one unit (arterial catheter: AC group), but not in the second (controls). Treatment was otherwise in accordance with recent guidelines. Children from the two units were matched according to age and PRISM score value. Mortality and limb or skin necrosis rates were compared and catheter-related complications were analyzed.


RESULTS
Among 156 children (1996-2004), 46 from each unit (median age: 25 months, median PRISM value: 19) could be matched. The mortality rate was 19.5% in the AC group and 21.7% in the control group (p=0.8). Nine children (6 survivors) in the AC group and 9 (8 survivors) of the controls had distal necroses (p=1). Fifty-three ACs were inserted in the AC-group children. Catheter-related complications were three hemorrhages or hematomas, one local thrombosis, and six transient distal ischemia; there were no major catheter-related complications. Distal necrosis incidence was not increased on limbs where catheters were inserted.


CONCLUSIONS
In this series of children with PF and suspected meningococcal sepsis, BP was monitored by arterial catheter in one unit; this did not affect limb and skin necrosis and mortality rates.
Khalil
Taher
T
PICU, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium.
Leteurtre
Stéphane
S
Fonteyne
Christine
C
Sadik
Ahmed
A
Biarent
Dominique
D
Leclerc
Francis
F
D001795:Blood Pressure Determination / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005121:Extremities / Q000473:pathology*; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications*; D008991:Monitoring, Physiologic / Q000379:methods*; D009336:Necrosis / Q000209:etiology*; D018570:Risk Assessment; D012867:Skin / Q000473:pathology*