A prospective observational study on practices and outcomes of initiation of inotropes in relation to resuscitation fluids in children with septic shock

Abstract

Objective: To study the practices and outcomes of initiation of inotropes in relation to resuscitation fluids boluses used in children with septic shock. Material and Methods: It was a Prospective observational study carried out from November 2014 to April 2016 at Pediatric emergency and PICU, LHMC and KSCH, New Delhi. Children aged 1 to 18 years with septic shock were included. Primary outcome was to look at various practices of initiation of inotropes; accordingly patients were categorized into 3 groups; N1 received inotropes after completion of first(20mL/kg),N2 after second(40mL/kg) and N3 after third (60mL/kg) bolus. Secondary outcome was to compare time taken, amount of fluid required to achieve hemodynamic stability, total fluid required and complications in first 24 hours of treatment. Study was approved by IEC. Results: Total 100 patients enrolled were grouped into N1(46), N2(10) and N3(44). Mean volume of fluid required to achieve hemodynamic stability in N1(40±10 mL/Kg) was significantly less than N2(70±10 mL/Kg) and N3(70±20mL/Kg);p=0.019. Mean time taken to achieve hemodynamic stability was significantly less in N1(115±45 minutes) than N2(196±32minutes) and N3(212±44minutes); p=0.021.Complications were lower in N1 (32%) than N2(40%) and N3(47%); p=0.036. Mean volume of Intravenous fluid required in first 24 hours of treatment in N1,N2 and N3 group was 122.4 ±22mL/kg, 151±31mL/kg and 145±24mL/kg respectively. Mortality difference in N1(17%), N2(30%) and N3(27%) was not significant. Conclusion: Early initiation of inotropes resulted in less total fluid volume, lesser time to achieve hemodynamic stability, less fluid boluses, and lesser complications in first 24 hours.