Critical care science · 2026
Hemodynamic monitoring in sepsis and septic shock in pediatric patients: a multicenter survey.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Cury Carolina Barone Quintella, Souza Daniela Carla de, Araujo Orlei Ribeiro de, Tonial Cristian Tedesco, Colleti Junior José, Prata-Barbosa Arnaldo, Lanziotti Vanessa Soares
Аннотация
OBJECTIVE: To evaluate the current practices of hemodynamic monitoring in sepsis and septic shock in Brazilian pediatric intensive care units.
METHODS: A multicenter, cross-sectional study using an electronic survey.
RESULTS: An electronic survey was responded to in three rounds (1 week each), and responses from 77 pediatric intensive care units in 26 states of Brazil were collected. Point-of-care cardiac ultrasound was the method of choice for fluid responsiveness evaluation in septic children in 61% pediatric intensive care units; 78% pediatric intensive care units had enough arterial line monitors available to every bed, but only 57% use invasive arterial blood pressure monitoring for every patient diagnosed with septic shock; 22% use invasive arterial blood pressure monitoring just for refractory shock patients. To guide initiation/titration of inotropes and vasoactive agents, 70% pediatric intensive care units said their decision is based on clinical assessment; 20% use point-of-care cardiac ultrasound to aid vasoactive agent choice; 88% pediatric intensive care units use Lactate trend, and 35% measure central/mixed venous saturation in patients with septic shock.
CONCLUSION: Differences between international guidelines and practice in Brazilian pediatric intensive care units regarding hemodynamic monitoring in pediatric sepsis were identified. These differences may arise for several reasons; recognizing them is crucial to making appropriate changes and adjusting valuable guidelines to make them more feasible for low- and middle-income countries.
METHODS: A multicenter, cross-sectional study using an electronic survey.
RESULTS: An electronic survey was responded to in three rounds (1 week each), and responses from 77 pediatric intensive care units in 26 states of Brazil were collected. Point-of-care cardiac ultrasound was the method of choice for fluid responsiveness evaluation in septic children in 61% pediatric intensive care units; 78% pediatric intensive care units had enough arterial line monitors available to every bed, but only 57% use invasive arterial blood pressure monitoring for every patient diagnosed with septic shock; 22% use invasive arterial blood pressure monitoring just for refractory shock patients. To guide initiation/titration of inotropes and vasoactive agents, 70% pediatric intensive care units said their decision is based on clinical assessment; 20% use point-of-care cardiac ultrasound to aid vasoactive agent choice; 88% pediatric intensive care units use Lactate trend, and 35% measure central/mixed venous saturation in patients with septic shock.
CONCLUSION: Differences between international guidelines and practice in Brazilian pediatric intensive care units regarding hemodynamic monitoring in pediatric sepsis were identified. These differences may arise for several reasons; recognizing them is crucial to making appropriate changes and adjusting valuable guidelines to make them more feasible for low- and middle-income countries.