‘Intermittent’ versus ‘continuous’ ScvO2 monitoring in children with septic shock: a randomised, non-inferiority trial
Purpose To compare the effect of ‘intermittent’ central venous oxygen saturation (ScvO 2 ) monitoring with ‘continuous’ ScvO 2 monitoring on shock resolution and mortality in children with septic shock. Methods Primary outcome was the achievement of therapeutic goals or shock resolution in the first...
Gespeichert in:
| Veröffentlicht in: | Intensive care medicine 2020, Vol.46 (1), p.82-92 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 92 |
|---|---|
| container_issue | 1 |
| container_start_page | 82 |
| container_title | Intensive care medicine |
| container_volume | 46 |
| creator | Sankar, Jhuma Singh, Man Kumar, Kiran Sankar, M. Jeeva Kabra, Sushil Kumar Lodha, Rakesh |
| description | Purpose
To compare the effect of ‘intermittent’ central venous oxygen saturation (ScvO
2
) monitoring with ‘continuous’ ScvO
2
monitoring on shock resolution and mortality in children with septic shock.
Methods
Primary outcome was the achievement of therapeutic goals or shock resolution in the first 6 h. We randomly assigned children |
| doi_str_mv | 10.1007/s00134-019-05858-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2320376019</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2343359550</sourcerecordid><originalsourceid>FETCH-LOGICAL-c267w-b421f665d18f9ab730a2a2ede692ac8577aab9176767eca027a32b8a04b337aa3</originalsourceid><addsrcrecordid>eNp9kctKAzEUhoMoWKsv4CrgxoXRXObqToqXQqELdR0ymYxNnSY1ybR0I30Mfb0-iakVBBeSxYGc7_855_wAnBJ8STDOrzzGhCUIkxLhtEgLtNwDPZIwighlxT7oYZZQlGQJPQRH3k8jnmcp6YH3zfpjaIJyMx2CMmGz_oQL5XznYexIa4I2ne389v9RLsYUzqzRwTptXqA2UE50Wztl4FKHCfRqHrSEfmLl6zUU0AlT25n2qr6AxhqkTaOcjuKwgsFp0R6Dg0a0Xp381D54vrt9Gjyg0fh-OLgZIUmzfImqhJImy9KaFE0pqpxhQQVVtcpKKmSR5rkQVRlXik9JgWkuGK0KgZOKsdhjfXC-8507-9YpH3icSqq2FUbF7ThlFLM8i_eL6NkfdGo7Z-J0kUoYS8s0xZGiO0o6671TDZ87PRNuxQnm20j4LhIeLfl3JHwZRWwn8vPt_ZT7tf5H9QWm15Tq</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2343359550</pqid></control><display><type>article</type><title>‘Intermittent’ versus ‘continuous’ ScvO2 monitoring in children with septic shock: a randomised, non-inferiority trial</title><source>SpringerLink Journals</source><creator>Sankar, Jhuma ; Singh, Man ; Kumar, Kiran ; Sankar, M. Jeeva ; Kabra, Sushil Kumar ; Lodha, Rakesh</creator><creatorcontrib>Sankar, Jhuma ; Singh, Man ; Kumar, Kiran ; Sankar, M. Jeeva ; Kabra, Sushil Kumar ; Lodha, Rakesh</creatorcontrib><description>Purpose
To compare the effect of ‘intermittent’ central venous oxygen saturation (ScvO
2
) monitoring with ‘continuous’ ScvO
2
monitoring on shock resolution and mortality in children with septic shock.
Methods
Primary outcome was the achievement of therapeutic goals or shock resolution in the first 6 h. We randomly assigned children < 17 years’ age with septic shock to ‘intermittent ScvO
2
’ or ‘continuous ScvO
2
’ groups. All children were subjected to subclavian/internal jugular line insertion and managed as per Surviving Sepsis Campaign Guidelines. To guide resuscitation, we used ScvO
2
estimated at other clinical and laboratory parameters were monitored similarly in both groups.
Results
We enrolled 75 and 77 children [median (IQR) age: 6 (1.5–10) years] in the ‘intermittent’ and ‘continuous’ groups, respectively. Baseline characteristics were comparable between the groups. When compared to the ‘continuous’ group, fewer children in the ‘intermittent’ group achieved shock resolution within first 6 h [19% vs. 36%; relative risk (RR) 0.51; 95% CI 0.29–0.89; risk difference − 18.0%; 95% CI − 32.0 to − 4.0]. The lower bound of confidence interval, however, crossed the pre-specified non-inferiority margin. There was no difference in the proportion of children attaining shock resolution within 24 h (63% vs. 69%; RR 0.86; 95% CI 0.68–1.08) or risk of mortality between the groups (47% vs. 43%; RR 1.06; 95% CI 0.74–1.51).
Conclusions
Given that a greater proportion of children attained therapeutic end points in the first 6 h, continuous monitoring of ScvO
2
should preferably be used to titrate therapy in the first few hours in children with septic shock. In the absence of such facility, intermittent monitoring of ScvO
2
can be used to titrate therapy in these children, given the lack of difference in the proportion of patients achieving shock resolution at 24 h or in risk of mortality between the intermittent and continuous groups.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-019-05858-w</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Anesthesiology ; Children ; Confidence intervals ; Critical Care Medicine ; Emergency Medicine ; Intensive ; Intensive care ; Lower bounds ; Medicine ; Medicine & Public Health ; Monitoring ; Mortality ; Oxygen content ; Pain Medicine ; Pediatric Original ; Pediatrics ; Pneumology/Respiratory System ; Resuscitation ; Risk ; Sepsis ; Septic shock ; Therapy</subject><ispartof>Intensive care medicine, 2020, Vol.46 (1), p.82-92</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2019</rights><rights>Intensive Care Medicine is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c267w-b421f665d18f9ab730a2a2ede692ac8577aab9176767eca027a32b8a04b337aa3</citedby><cites>FETCH-LOGICAL-c267w-b421f665d18f9ab730a2a2ede692ac8577aab9176767eca027a32b8a04b337aa3</cites><orcidid>0000-0002-9807-6550</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-019-05858-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-019-05858-w$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids></links><search><creatorcontrib>Sankar, Jhuma</creatorcontrib><creatorcontrib>Singh, Man</creatorcontrib><creatorcontrib>Kumar, Kiran</creatorcontrib><creatorcontrib>Sankar, M. Jeeva</creatorcontrib><creatorcontrib>Kabra, Sushil Kumar</creatorcontrib><creatorcontrib>Lodha, Rakesh</creatorcontrib><title>‘Intermittent’ versus ‘continuous’ ScvO2 monitoring in children with septic shock: a randomised, non-inferiority trial</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><description>Purpose
To compare the effect of ‘intermittent’ central venous oxygen saturation (ScvO
2
) monitoring with ‘continuous’ ScvO
2
monitoring on shock resolution and mortality in children with septic shock.
Methods
Primary outcome was the achievement of therapeutic goals or shock resolution in the first 6 h. We randomly assigned children < 17 years’ age with septic shock to ‘intermittent ScvO
2
’ or ‘continuous ScvO
2
’ groups. All children were subjected to subclavian/internal jugular line insertion and managed as per Surviving Sepsis Campaign Guidelines. To guide resuscitation, we used ScvO
2
estimated at other clinical and laboratory parameters were monitored similarly in both groups.
Results
We enrolled 75 and 77 children [median (IQR) age: 6 (1.5–10) years] in the ‘intermittent’ and ‘continuous’ groups, respectively. Baseline characteristics were comparable between the groups. When compared to the ‘continuous’ group, fewer children in the ‘intermittent’ group achieved shock resolution within first 6 h [19% vs. 36%; relative risk (RR) 0.51; 95% CI 0.29–0.89; risk difference − 18.0%; 95% CI − 32.0 to − 4.0]. The lower bound of confidence interval, however, crossed the pre-specified non-inferiority margin. There was no difference in the proportion of children attaining shock resolution within 24 h (63% vs. 69%; RR 0.86; 95% CI 0.68–1.08) or risk of mortality between the groups (47% vs. 43%; RR 1.06; 95% CI 0.74–1.51).
Conclusions
Given that a greater proportion of children attained therapeutic end points in the first 6 h, continuous monitoring of ScvO
2
should preferably be used to titrate therapy in the first few hours in children with septic shock. In the absence of such facility, intermittent monitoring of ScvO
2
can be used to titrate therapy in these children, given the lack of difference in the proportion of patients achieving shock resolution at 24 h or in risk of mortality between the intermittent and continuous groups.</description><subject>Anesthesiology</subject><subject>Children</subject><subject>Confidence intervals</subject><subject>Critical Care Medicine</subject><subject>Emergency Medicine</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Lower bounds</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Monitoring</subject><subject>Mortality</subject><subject>Oxygen content</subject><subject>Pain Medicine</subject><subject>Pediatric Original</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Resuscitation</subject><subject>Risk</subject><subject>Sepsis</subject><subject>Septic shock</subject><subject>Therapy</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp9kctKAzEUhoMoWKsv4CrgxoXRXObqToqXQqELdR0ymYxNnSY1ybR0I30Mfb0-iakVBBeSxYGc7_855_wAnBJ8STDOrzzGhCUIkxLhtEgLtNwDPZIwighlxT7oYZZQlGQJPQRH3k8jnmcp6YH3zfpjaIJyMx2CMmGz_oQL5XznYexIa4I2ne389v9RLsYUzqzRwTptXqA2UE50Wztl4FKHCfRqHrSEfmLl6zUU0AlT25n2qr6AxhqkTaOcjuKwgsFp0R6Dg0a0Xp381D54vrt9Gjyg0fh-OLgZIUmzfImqhJImy9KaFE0pqpxhQQVVtcpKKmSR5rkQVRlXik9JgWkuGK0KgZOKsdhjfXC-8507-9YpH3icSqq2FUbF7ThlFLM8i_eL6NkfdGo7Z-J0kUoYS8s0xZGiO0o6671TDZ87PRNuxQnm20j4LhIeLfl3JHwZRWwn8vPt_ZT7tf5H9QWm15Tq</recordid><startdate>2020</startdate><enddate>2020</enddate><creator>Sankar, Jhuma</creator><creator>Singh, Man</creator><creator>Kumar, Kiran</creator><creator>Sankar, M. Jeeva</creator><creator>Kabra, Sushil Kumar</creator><creator>Lodha, Rakesh</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9807-6550</orcidid></search><sort><creationdate>2020</creationdate><title>‘Intermittent’ versus ‘continuous’ ScvO2 monitoring in children with septic shock: a randomised, non-inferiority trial</title><author>Sankar, Jhuma ; Singh, Man ; Kumar, Kiran ; Sankar, M. Jeeva ; Kabra, Sushil Kumar ; Lodha, Rakesh</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c267w-b421f665d18f9ab730a2a2ede692ac8577aab9176767eca027a32b8a04b337aa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anesthesiology</topic><topic>Children</topic><topic>Confidence intervals</topic><topic>Critical Care Medicine</topic><topic>Emergency Medicine</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Lower bounds</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Monitoring</topic><topic>Mortality</topic><topic>Oxygen content</topic><topic>Pain Medicine</topic><topic>Pediatric Original</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Resuscitation</topic><topic>Risk</topic><topic>Sepsis</topic><topic>Septic shock</topic><topic>Therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sankar, Jhuma</creatorcontrib><creatorcontrib>Singh, Man</creatorcontrib><creatorcontrib>Kumar, Kiran</creatorcontrib><creatorcontrib>Sankar, M. Jeeva</creatorcontrib><creatorcontrib>Kabra, Sushil Kumar</creatorcontrib><creatorcontrib>Lodha, Rakesh</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sankar, Jhuma</au><au>Singh, Man</au><au>Kumar, Kiran</au><au>Sankar, M. Jeeva</au><au>Kabra, Sushil Kumar</au><au>Lodha, Rakesh</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>‘Intermittent’ versus ‘continuous’ ScvO2 monitoring in children with septic shock: a randomised, non-inferiority trial</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><date>2020</date><risdate>2020</risdate><volume>46</volume><issue>1</issue><spage>82</spage><epage>92</epage><pages>82-92</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><abstract>Purpose
To compare the effect of ‘intermittent’ central venous oxygen saturation (ScvO
2
) monitoring with ‘continuous’ ScvO
2
monitoring on shock resolution and mortality in children with septic shock.
Methods
Primary outcome was the achievement of therapeutic goals or shock resolution in the first 6 h. We randomly assigned children < 17 years’ age with septic shock to ‘intermittent ScvO
2
’ or ‘continuous ScvO
2
’ groups. All children were subjected to subclavian/internal jugular line insertion and managed as per Surviving Sepsis Campaign Guidelines. To guide resuscitation, we used ScvO
2
estimated at other clinical and laboratory parameters were monitored similarly in both groups.
Results
We enrolled 75 and 77 children [median (IQR) age: 6 (1.5–10) years] in the ‘intermittent’ and ‘continuous’ groups, respectively. Baseline characteristics were comparable between the groups. When compared to the ‘continuous’ group, fewer children in the ‘intermittent’ group achieved shock resolution within first 6 h [19% vs. 36%; relative risk (RR) 0.51; 95% CI 0.29–0.89; risk difference − 18.0%; 95% CI − 32.0 to − 4.0]. The lower bound of confidence interval, however, crossed the pre-specified non-inferiority margin. There was no difference in the proportion of children attaining shock resolution within 24 h (63% vs. 69%; RR 0.86; 95% CI 0.68–1.08) or risk of mortality between the groups (47% vs. 43%; RR 1.06; 95% CI 0.74–1.51).
Conclusions
Given that a greater proportion of children attained therapeutic end points in the first 6 h, continuous monitoring of ScvO
2
should preferably be used to titrate therapy in the first few hours in children with septic shock. In the absence of such facility, intermittent monitoring of ScvO
2
can be used to titrate therapy in these children, given the lack of difference in the proportion of patients achieving shock resolution at 24 h or in risk of mortality between the intermittent and continuous groups.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><doi>10.1007/s00134-019-05858-w</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-9807-6550</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0342-4642 |
| ispartof | Intensive care medicine, 2020, Vol.46 (1), p.82-92 |
| issn | 0342-4642 1432-1238 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2320376019 |
| source | SpringerLink Journals |
| subjects | Anesthesiology Children Confidence intervals Critical Care Medicine Emergency Medicine Intensive Intensive care Lower bounds Medicine Medicine & Public Health Monitoring Mortality Oxygen content Pain Medicine Pediatric Original Pediatrics Pneumology/Respiratory System Resuscitation Risk Sepsis Septic shock Therapy |
| title | ‘Intermittent’ versus ‘continuous’ ScvO2 monitoring in children with septic shock: a randomised, non-inferiority trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-19T02%3A01%3A32IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=%E2%80%98Intermittent%E2%80%99%20versus%20%E2%80%98continuous%E2%80%99%20ScvO2%20monitoring%20in%20children%20with%20septic%20shock:%20a%20randomised,%20non-inferiority%20trial&rft.jtitle=Intensive%20care%20medicine&rft.au=Sankar,%20Jhuma&rft.date=2020&rft.volume=46&rft.issue=1&rft.spage=82&rft.epage=92&rft.pages=82-92&rft.issn=0342-4642&rft.eissn=1432-1238&rft_id=info:doi/10.1007/s00134-019-05858-w&rft_dat=%3Cproquest_cross%3E2343359550%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2343359550&rft_id=info:pmid/&rfr_iscdi=true |