title: A survey of stated physician practices and beliefs on the use of steroids in pediatric fluid and/or vasoactive infusion-dependent shock.
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.
  
  
  METHODS
  Cross-sectional, Internet-based survey.
  
  
  METHODS
  Canada.
  
  
  METHODS
  Physicians identified as practicing pediatric intensive care in any of 15 academic centers.
  
  
  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.
authors.affiliation: Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada. menon@cheo.on.ca
authors.forename: Kusum
authors.initials: K
authors.lastname: Menon
authors.forename: James D
authors.initials: JD
authors.lastname: McNally
authors.forename: Karen
authors.initials: K
authors.lastname: Choong
authors.forename: Roxanne E
authors.initials: RE
authors.lastname: Ward
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Lawson
authors.forename: Tim
authors.initials: T
authors.lastname: Ramsay
authors.forename: Hector R
authors.initials: HR
authors.lastname: Wong
mesh_terms: D000304:Adrenal Cortex Function Tests / Q000706:statistics & numerical data; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002170:Canada; D002317:Cardiovascular Agents / Q000009:adverse effects*; D002648:Child; D003430:Cross-Sectional Studies; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D012772:Shock, Septic / Q000188:drug therapy* / Q000209:etiology; D011795:Surveys and Questionnaires
chemical_list: D000305:Adrenal Cortex Hormones; D002317:Cardiovascular Agents