A survey of stated physician practices and beliefs on the use of steroids in pediatric fluid and/or vasoactive infusion-dependent shock.

Abstract

OBJECTIVE:

Limited evidence exists on the use of corticosteroids in pediatric shock. We sought to determine physicians' practices and beliefs with regard to the management of pediatric shock.

DESIGN:

Cross-sectional, Internet-based survey.

SETTING:

Canada.

SUBJECTS:

Physicians identified as practicing pediatric intensive care in any of 15 academic centers.

MEASUREMENTS AND MAIN RESULTS:

Seventy of 97 physicians (72.2%) responded. Physicians stated that they were more likely to prescribe steroids for septic shock than for shock following cardiac surgery (odds ratio, 1.9 [95% CI, 0.9-4.3]) or trauma (odds ratio, 11.46 [95% CI, 2.5-51.2]), and 91.4% (64/70) would administer steroids to patients who had received 60 cc/kg of fluid and two or more vasoactive medications. Thirty-five percent of respondents (25/70) reported that they rarely or never conducted adrenal axis testing before giving steroids to patients in shock. Eighty-seven percent of respondents (61/70) stated that the role of steroids in the treatment of fluid and/or vasoactive drug-dependent shock needed to be clarified and that 84.3% would be willing to randomize patients into a trial of steroid efficacy who were fluid resuscitated and on one high-dose vasoactive medication. However, 74.3% stated that they would start open-label steroids in patients who required two high-dose vasoactive medications.

CONCLUSIONS:

This survey provides information on the stated beliefs and practices of pediatric critical care physicians with regard to the use of steroids in fluid and/or vasoactive drug-dependent shock. Clinicians feel that the role of steroids in shock still requires clarification and that they would be willing to randomize patients into a trial. This survey may be useful as an initial framework for the development of a future trial on the use of steroids in pediatric shock.

• Authors: Kusum Menon, James D McNally, Karen Choong, Roxanne E Ward, Margaret L Lawson, Tim Ramsay, Hector R Wong
• Journal: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (Pediatr Crit Care Med) Vol. 14 Issue 5 Pg. 462-6 (Jun 2013) ISSN: 1529-7535 [Print] United States
• PMID: 23628832 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenal Cortex Hormones
• Cardiovascular Agents

Topics

• Adrenal Cortex Function Tests (statistics & numerical data)
• Adrenal Cortex Hormones (therapeutic use)
• Attitude of Health Personnel
• Canada
• Cardiovascular Agents (adverse effects)
• Child
• Cross-Sectional Studies
• Fluid Therapy (adverse effects)
• Humans
• Intensive Care Units, Pediatric
• Practice Patterns, Physicians' (statistics & numerical data)
• Randomized Controlled Trials as Topic
• Shock, Septic (drug therapy, etiology)
• Surveys and Questionnaires