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Aleksandrovich Yu.S.
Children’s Scientific Clinical Center for Infectious Diseases
Serednyakov K.V.
Children’s Research and Clinical Center for Infectious Diseases of the FMBA of Russia;
St. Petersburg State Pediatric Medical University
Rybyanov V.V.
St. Petersburg State Pediatric Medical University
Pshenisnov K.V.
Children’s Scientific Clinical Center for Infectious Diseases
Prediction of septic shock outcome in children requiring extracorporeal hemocorrection
Journal: Russian Journal of Anesthesiology and Reanimatology. 2022;(6): 44‑51
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To cite this article:
Aleksandrovich YuS, Serednyakov KV, Rybyanov VV, Pshenisnov KV. Prediction of septic shock outcome in children requiring extracorporeal hemocorrection. Russian Journal of Anesthesiology and Reanimatology.
2022;(6):44‑51. (In Russ.)
https://doi.org/10.17116/anaesthesiology202206144
Treatment of septic shock in children is a key issue in pediatric intensive care.
To identify significant clinical and laboratory predictors of septic shock outcomes in children requiring extracorporeal hemocorrection (EH).
A multiple-center observational uncontrolled study included 62 children. Mean age was 5 (2—13) years. Patients were divided into 3 groups depending on timing and technique of EH. In the 1st group, EH was started as soon as signs of acute kidney injury (AKI) were found. In the 2nd group, EH was initiated prior to AKI and in patients with AKI stage 1. In these groups, patients underwent only continuous veno-venous hemodiafiltration (CVVHDF). In the 3rd group, EH was initiated immediately after diagnosis of septic shock (CVVHDF combined with polymyxin hemosrbition). Endotoxin activity and need for inotropic and vasopressor support were evaluated to assess therapeutic efficacy.
PRISM score has the greatest prognostic value in the 2nd group (p<0.047), whereas pSOFA score was significant in the 1st and 2nd groups (p<0.039). Catecholamine index was of great prognostic value in the 1st and 2nd groups (p<0.045). Serum lactate was more informative in the 2nd and 3rd groups (p<0.042). pSOFA score >11, PRISM-3 score >15, catecholamine index >3.9 and serum lactate >6.9 mmol/L were significant predictors of mortality.
PSOFA score >11 is an absolute indication for extracorporeal hemocorrection early after admission to ICU.
Keywords:
Authors:
Aleksandrovich Yu.S.
Children’s Scientific Clinical Center for Infectious Diseases
Serednyakov K.V.
Children’s Research and Clinical Center for Infectious Diseases of the FMBA of Russia;
St. Petersburg State Pediatric Medical University
Rybyanov V.V.
St. Petersburg State Pediatric Medical University
Pshenisnov K.V.
Children’s Scientific Clinical Center for Infectious Diseases
Received:
03.05.2022
Accepted:
11.09.2022
List of references:
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