title: Early goal-directed therapy in pediatric septic shock: comparison of outcomes "with" and "without" intermittent superior venacaval oxygen saturation monitoring: a prospective cohort study*.
abstract: OBJECTIVE
  To evaluate the effect of intermittent central venous oxygen saturation monitoring (ScvO(2)) on critical outcomes in children with septic shock, as continuous monitoring may not be feasible in most resource-restricted settings.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  PICU of a tertiary care teaching hospital.
  
  
  METHODS
  Consecutive children younger than 17 years with fluid refractory septic shock admitted to our ICU from November 2010 to October 2012 were included.
  
  
  METHODS
  Enrolled children were subjected to subclavian/internal jugular catheter insertion. Those in whom it was successful formed the "exposed" group (ScvO(2) group), whereas the rest constituted the control group (no ScvO(2) group). In the former group, intermittent ScvO(2) monitoring at 1, 3, and 6 hours was used to guide resuscitation, whereas in the latter, only clinical variables were used.
  
  
  RESULTS
  The major outcomes were in-hospital mortality and achievement of therapeutic goals within first 6 hours. One hundred twenty children were enrolled in the study-63 in the ScvO(2) group and 57 in the no ScvO(2) group. Baseline characteristics including the organ dysfunction and mortality risk scores were comparable between the groups. Children in the ScvO(2) group had significantly lower in-hospital mortality (33.3% vs 54%; relative risk, 0.61; 95% CI, 0.4, 0.93; number needed to treat, 5; 95% CI, 3, 27). A greater proportion of children in exposed group achieved therapeutic endpoints in first 6 hours (43% vs 23%, p = 0.02) and during entire ICU stay (71% vs 51%, p = 0.02). The mean number of dysfunctional organs was also significantly lesser in ScvO(2) group in comparison with no ScvO(2) group (2 vs 3, p < 0.001).
  
  
  CONCLUSIONS
  Early goal-directed therapy using intermittent ScvO(2) monitoring seemed to reduce the mortality rates and improved organ dysfunction in children with septic shock as compared with those without such monitoring.
authors.affiliation: 1Department of Pediatrics, PGIMER, Dr. RML Hospital, New Delhi, India. 2Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Jhuma
authors.initials: J
authors.lastname: Sankar
authors.forename: M Jeeva
authors.initials: MJ
authors.lastname: Sankar
authors.forename: C P
authors.initials: CP
authors.lastname: Suresh
authors.forename: Nandkishore K
authors.initials: NK
authors.lastname: Dubey
authors.forename: Archana
authors.initials: A
authors.lastname: Singh
mesh_terms: D062186:Arterial Pressure; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002405:Catheterization, Central Venous; D002496:Central Venous Pressure; D002648:Child; D002675:Child, Preschool; D004280:Dobutamine / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D005260:Female; D005440:Fluid Therapy; D006339:Heart Rate; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000097:blood*; D011446:Prospective Studies; D012121:Respiration, Artificial; D012772:Shock, Septic / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014683:Vena Cava, Superior
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine; D010100:Oxygen; D004298:Dopamine