ADJUNCTIVE CORTICOSTEROID THERAPY IN PEDIATRIC SEVERE SEPSIS: OBSERVATION FROM THE RESOLVE STUDY

Zimmerman JJ, Williams MD. Pediatr Crit Care Med. 2011;12(1):2-8.

This retrospective cohort study sought to examine the clinical data-based derived from the RESOLVE (Researching Severe Sepsis and Organ Dysfunction in Children: A Global Perspective) and assess whether corticosteroids used as adjunctive therapy in pediatric sepsis is associated with improved outcomes in these patients. Data from 104 pediatric centers from 18 countries that were in the original data were gathered.

Children with severe sepsis (n = 477) who required both vasoactive-inotropic infusion and mechanical ventilation were the subjects of this study. Of this number, 193 received corticosteroids, and 284 did not. Demographic and mean Pediatric Risk of Mortality scores and mean number of organ dysfunction were obtained, and use of corticosteroids were both therapeutic (89%-mostly shock) and prophylactic (13%).

The authors concluded children with severe sepsis who received adjunctive corticosteroid therapy had similar illness severity as those children who did not receive adjunctive corticosteroid therapy, showing no definite improvement in outcomes.

ENHANCING MONITORING IMPROVES PEDIATRIC TRANSPORT OUTCOMES: A RANDOMIZED CONTROLLED TRIAL

Stroud MH, Prodhan P, Moss M, Fiser R, Schexnayder S, Anand K. Pediatrics. 2011;127(1):42-48.

The authors hypothesized that improved blood pressure monitoring would lead to enhanced interventions during transport with improved outcomes and reduced length of hospital stay for critically ill pediatric transport patients. This was a single-center randomized controlled trial. Study period was from May 2006 to June 2007.

This study included only patients who were transported via helicopter with the Angel One Transport Team at the Arkansas Children's Hospital. Patients included those with systemic inflammatory response syndrome and moderate-to-severe head injury. Patients in the control group had their blood pressure monitored with an oscillometric device intermittently, whereas those in the intervention group had their blood pressure monitored every 12 to 15 cardiac contractions with a near-continuous device. Ninety-four (48 in control group, 46 in the intervention group) patients were enrolled in this study.

The study found that those patients in the intervention group received more intravenous fluids, had a shorter hospital stay, and had less organ dysfunction. The study concluded that improved monitoring during pediatric transport had the potential to improve outcomes of critically ill children.