Risk Factors for Mortality in Refractory Pediatric Septic Shock Supported with Extracorporeal Life Support.
Risk Factors for Mortality in Refractory Pediatric Septic Shock Supported with Extracorporeal Life Support.
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DOI：
10.1097/mat.0000000000001147
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN)
中科院分区：
文献类型：
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作者：
Workman JK;Bailly DK;Reeder RW;Dalton HJ;Berg RA;Shanley TP;Newth CJL;Pollack MM;Wessel D;Carcillo J;Harrison R;Dean JM;Meert KL;Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN)
难治性小儿感染性休克接受体外生命支持（ECLS）的死亡危险因素在很大程度上是未知的。因此，我们进行了单变量和多变量分析，以确定2012年1月至2014年9月期间在8家三级儿科医院接受ECLS手术并根据2005年国际共识标准发生脓毒性休克的儿童（<19岁）死亡的危险因素。在研究期间接受ECLS治疗的514名儿童中，70名被确定为感染性休克。感染性休克组（54.3%）和非感染性休克组（43.7%）的死亡率相似。在感染性休克患者中，与呼吸衰竭相比，ECLS插管指征为心力衰竭或体外心肺复苏（ECPR） （P = 0.003），插管后出现新的神经系统事件（P = 0.032），插管后出现新的感染（P = 0.005）， ECLS插管后48小时内pH值无法正常化（P = 0.010），并且需要更高的每日血小板输液量（P = 0.005）。这些发现可用于帮助指导对医疗管理难治性脓毒性休克患儿的临床决策。
Risk factors for mortality in children with refractory pediatric septic shock who are supported with extracorporeal life support (ECLS) are largely unknown. Therefore, we performed univariable and multivariable analyses to determine risk factors for mortality among children (<19 years) who underwent an ECLS run between January 2012 and September 2014 at eight tertiary pediatric hospitals, and who had septic shock based on 2005 International Consensus Criteria. Of the 514 children treated with ECLS during the study period, 70 were identified with septic shock. The mortality rate was similar between those with (54.3%) and without septic shock (43.7%). Among those with septic shock, significant risk factors for mortality included cardiac failure or extracorporeal cardiopulmonary resuscitation (ECPR) as indication for ECLS cannulation compared with respiratory failure (P = 0.003), having a new neurologic event following cannulation (P = 0.032), acquiring a new infection following cannulation (P = 0.005), inability to normalize pH in the 48 hours following ECLS cannulation (P = 0.010), and requiring higher daily volume of platelet transfusions (P = 0.005). These findings can be used to help guide clinical decision making for children with septic shock that is refractory to medical management.