Evaluation of Early Corticosteroid Therapy in Management of Pediatric Septic Shock in Pediatric Intensive Care Patients: A Randomized Clinical Study. El-Nawawy, A., Khater, D., Omar, H., & Wali, Y. The Pediatric Infectious Disease Journal, 36(2):155–159, October, 2016. ![Evaluation of Early Corticosteroid Therapy in Management of Pediatric Septic Shock in Pediatric Intensive Care Patients: A Randomized Clinical Study. [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex BACKGROUND:Septic shock is a major healthcare problem. Adrenal insufficiency in children with septic shock is a recognized complication, yet is controversial regarding its management and effect on mortality. According to the current guidelines, children with risk factors for adrenal insufficiency should receive a stress dose of steroids in step 3 of treatment. This study aimed to evaluate and compare early corticosteroid therapy with the traditional use of steroids among pediatric septic shock patients. METHODS:This prospective randomized interventional clinical study included 3 groups of patients (32 each) and was conducted in Alexandria University PICU. By protocol the first group received steroids in step 3 of the treatment according to the current international guidelines (group A)and the second group was managed as group A and was tested for adrenal insufficiency (AI) by adrenal stimulation test using intramuscular ACTH (Cosyntropin) (group B). The third group received steroids at the start of fluid therapy (group C). A 4th group (D), was created by adding patients from group A and B who needed corticosteroids in the third stage of therapy according to the international protocol in one group. All patients were evaluated for basal serum cortisol and plasma ACTH concentrations. RESULTS:The data showed a statistically significant shorter shock reversal time among patients receiving corticosteroids at the start of treatment compared with those who received it at the 3rd step of treatment (P= 0.046); however, mortality was not statistically different among the groups. Additionally, there was no superinfection in cases receiving early steroid therapy. CONCLUSION:Early use of corticosteroid in patients with septic shock might shorten the shock reversal time without increase in mortality or super-infection.
@article{el-nawawy_evaluation_2016,
title = {Evaluation of {Early} {Corticosteroid} {Therapy} in {Management} of {Pediatric} {Septic} {Shock} in {Pediatric} {Intensive} {Care} {Patients}: {A} {Randomized} {Clinical} {Study}.},
volume = {36},
url = {http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=27798546&retmode=ref&cmd=prlinks},
doi = {10.1097/inf.0000000000001380},
abstract = {BACKGROUND:Septic shock is a major healthcare problem. Adrenal insufficiency in children with septic shock is a recognized complication, yet is controversial regarding its management and effect on mortality. According to the current guidelines, children with risk factors for adrenal insufficiency should receive a stress dose of steroids in step 3 of treatment. This study aimed to evaluate and compare early corticosteroid therapy with the traditional use of steroids among pediatric septic shock patients. METHODS:This prospective randomized interventional clinical study included 3 groups of patients (32 each) and was conducted in Alexandria University PICU. By protocol the first group received steroids in step 3 of the treatment according to the current international guidelines (group A)and the second group was managed as group A and was tested for adrenal insufficiency (AI) by adrenal stimulation test using intramuscular ACTH (Cosyntropin) (group B). The third group received steroids at the start of fluid therapy (group C). A 4th group (D), was created by adding patients from group A and B who needed corticosteroids in the third stage of therapy according to the international protocol in one group. All patients were evaluated for basal serum cortisol and plasma ACTH concentrations. RESULTS:The data showed a statistically significant shorter shock reversal time among patients receiving corticosteroids at the start of treatment compared with those who received it at the 3rd step of treatment (P= 0.046); however, mortality was not statistically different among the groups. Additionally, there was no superinfection in cases receiving early steroid therapy. CONCLUSION:Early use of corticosteroid in patients with septic shock might shorten the shock reversal time without increase in mortality or super-infection.},
number = {2},
journal = {The Pediatric Infectious Disease Journal},
author = {El-Nawawy, Ahmed and Khater, Doaa and Omar, Heba and Wali, Yasser},
month = oct,
year = {2016},
pages = {155--159},
}
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Adrenal insufficiency in children with septic shock is a recognized complication, yet is controversial regarding its management and effect on mortality. According to the current guidelines, children with risk factors for adrenal insufficiency should receive a stress dose of steroids in step 3 of treatment. This study aimed to evaluate and compare early corticosteroid therapy with the traditional use of steroids among pediatric septic shock patients. METHODS:This prospective randomized interventional clinical study included 3 groups of patients (32 each) and was conducted in Alexandria University PICU. By protocol the first group received steroids in step 3 of the treatment according to the current international guidelines (group A)and the second group was managed as group A and was tested for adrenal insufficiency (AI) by adrenal stimulation test using intramuscular ACTH (Cosyntropin) (group B). The third group received steroids at the start of fluid therapy (group C). A 4th group (D), was created by adding patients from group A and B who needed corticosteroids in the third stage of therapy according to the international protocol in one group. All patients were evaluated for basal serum cortisol and plasma ACTH concentrations. RESULTS:The data showed a statistically significant shorter shock reversal time among patients receiving corticosteroids at the start of treatment compared with those who received it at the 3rd step of treatment (P= 0.046); however, mortality was not statistically different among the groups. Additionally, there was no superinfection in cases receiving early steroid therapy. 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Adrenal insufficiency in children with septic shock is a recognized complication, yet is controversial regarding its management and effect on mortality. According to the current guidelines, children with risk factors for adrenal insufficiency should receive a stress dose of steroids in step 3 of treatment. This study aimed to evaluate and compare early corticosteroid therapy with the traditional use of steroids among pediatric septic shock patients. METHODS:This prospective randomized interventional clinical study included 3 groups of patients (32 each) and was conducted in Alexandria University PICU. By protocol the first group received steroids in step 3 of the treatment according to the current international guidelines (group A)and the second group was managed as group A and was tested for adrenal insufficiency (AI) by adrenal stimulation test using intramuscular ACTH (Cosyntropin) (group B). The third group received steroids at the start of fluid therapy (group C). A 4th group (D), was created by adding patients from group A and B who needed corticosteroids in the third stage of therapy according to the international protocol in one group. All patients were evaluated for basal serum cortisol and plasma ACTH concentrations. RESULTS:The data showed a statistically significant shorter shock reversal time among patients receiving corticosteroids at the start of treatment compared with those who received it at the 3rd step of treatment (P= 0.046); however, mortality was not statistically different among the groups. Additionally, there was no superinfection in cases receiving early steroid therapy. 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