Abstract | OBJECTIVE: DESIGN: Prospective, randomized, open-label trial. SETTING: Pediatric Emergency and Intensive Care Unit of a tertiary care referral and teaching hospital. SUBJECTS AND INCLUSION CRITERIA: Sixty patients, between 1 month to 12 years of age, with septic shock, without clinical evidence of organ failure at admission or underlying immunodeficiency. INTERVENTION:
Resuscitation with normal saline or polymer from degraded gelatin ( Haemaccel) in the boluses rate of 20 mL/kg till hemodynamic stabilization or if central venous pressure (CVP) exceeded 10 mmHg (fluid requirement beyond 40 mL/kg guided by BP and CVP). METHODS: Hemodynamic parameters (heart rate, capillary filling time, pulse volume, and blood pressure) were recorded before and during resuscitation, and then 2 hourly for 12 hours. Central venous pressure line was placed within first hour, soon after starting fluids. Estimation of plasma volume and body water was done at the end of first hour of fluid resuscitation. OUTCOME MEASURES: Hemodynamic stabilization (heart rate, capillary refill time, systolic BP in normal range), plasma volume at the end of fluid resuscitation and incidence of organ dysfunction. RESULTS: 31 patients were randomized to normal saline and 29 to gelatin polymer. Both the groups were similar with respect to age, gender, primary diagnosis, initial hemodynamic parameters and PRISM score. Pneumonia (n = 22; 36%), gut-associated sepsis (n = 13), and dengue hemorrhagic fever (n = 11) were the common primary diagnosis. Initial hemodynamic stabilization was achieved in all. The mean (SD plasma volume (saline--53.4 (2.0 mL/kg, gelatin polymer--53.2 (1.9 mL/kg), extracellular fluid volume, total body water and interstitial fluid volume at the end of first hour of resuscitation were similar. The requirement of inotropes, incidence of organ dysfunction and case fatality rate (Saline--29%, gelatin polymer--31%), were similar in two groups. CONCLUSION:
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Authors | Manasaranjan Upadhyay, Sunit Singhi, Jayashree Murlidharan, Navkiran Kaur, S Majumdar |
Journal | Indian pediatrics
(Indian Pediatr)
Vol. 42
Issue 3
Pg. 223-31
(Mar 2005)
ISSN: 0019-6061 [Print] India |
PMID | 15817970
(Publication Type: Journal Article, Randomized Controlled Trial)
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Chemical References |
- Crystalloid Solutions
- Isotonic Solutions
- Plasma Substitutes
- Polygeline
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Topics |
- Child
- Child, Preschool
- Crystalloid Solutions
- Female
- Fluid Therapy
(methods)
- Humans
- Infant
- Infant, Newborn
- Intensive Care Units, Pediatric
- Isotonic Solutions
(therapeutic use)
- Male
- Plasma Substitutes
(therapeutic use)
- Polygeline
(therapeutic use)
- Prospective Studies
- Shock, Septic
(therapy)
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