A SURVEY OF STATED PHYSICIAN PRACTICES AND BELIEFS ON THE USE OF STEROIDS IN PEDIATRIC FLUID AND/OR VASOACTIVE INFUSION-DEPENDENT SHOCK

Menon K, McNally JD, Choong K, Ward RE, Lawson ML, Ramsay T, Wong HR. Pediatr Crit Care Med. 2013;1(5):462-466.

In Canada, approximately 2000 children per year develop signs of clinical shock requiring lifesaving treatments. Steroids have been used as an adjunct therapy in this treatment with limited consensus on the implications and administration. In this study, the researchers sought to determine physician practices and beliefs in regard to management of pediatric shock and the use of steroids.

This study used a cross-sectional, Internet-based survey by physicians identified as practicing pediatric intensive care (n = 97) from 15 academic centers. Seventy physicians responded (72.2%). Physicians responded they were more likely to use steroids for septic shock than for shock following cardiac surgery (odds ratio, 1.9) or trauma (odds ratio, 11.46), and 91.4% would administer steroids to patients who had received 60 mL/kg of fluid and 2 or more vasoactive medications. Eighty-seven percent of respondents (61/70) stated the role of steroids in fluid and/or vasoactive drug-dependent shock needed further clarification and established guidelines.

The researcher concluded that clinicians feel the role of steroids in shock requires clarification, and they would be willing to randomize patients into a trial. The authors state their survey may be used as an initial framework for future studies on the use of steroids in pediatric shock.

THE IMPACT OF POSTINTUBATION CHEST RADIOGRAPH DURING PEDIATRIC AND NEONATAL CRITICAL CARE TRANSPORT

Sanchez-Pinto N, Giuliano JS, Schwartz HP, Garrett L, Gothard MD, Kantak A, Bigham MT. Pediatr Crit Care Med. 2013;14(5).

The researchers in this prospective observational study hypothesized that routine postintubation chest radiograph to confirm tracheal tube position was noninformational and could be eliminated to improve efficiency with no patient safety comprise during transport. The researchers used the rate of tracheal tube repositioning and on-scene time as their study outcomes.

This study included all patients intubated by a children's hospital-based pediatric/neonatal transport team (n = 77; 43 pediatric, 34 neonatal) during an 18-month study period. A postintubation chest radiograph was obtained in 85.7% of the cases and showed 47% of those patients had tracheal tube malposition. When comparing means of on-scene times for patients with/without postintubation chest radiograph, the neonatal patients were saved, and an average of 33 minutes when on chest radiograph was obtained. The authors state there was no statistical difference in on-scene time for pediatric patients who did or did not receive postintubation chest radiograph.

The authors conclude that postintubation chest radiographs may extend the overall on-scene transport times in certain patients, but the chest radiographs remain informative in pediatric/neonatal critical care transport and should be obtained when feasible.