Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition
Identifieur interne : 003C62 ( Ncbi/Curation ); précédent : 003C61; suivant : 003C63Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition
Auteurs : Luc Morin [France] ; Samiran Ray [Royaume-Uni] ; Clare Wilson [Royaume-Uni] ; Solenn Remy [France] ; Mohamed Rida Benissa [France] ; Nicolaas J. G. Jansen [Pays-Bas] ; Etienne Javouhey [France] ; Mark J. Peters [Royaume-Uni] ; Martin Kneyber [Pays-Bas] ; Daniele De Luca [France] ; Simon Nadel [Royaume-Uni] ; Luregn Jan Schlapbach [Australie, Suisse] ; Graeme Maclaren [Australie, Singapour] ; Pierre Tissieres [France]Source :
- Intensive Care Medicine [ 0342-4642 ] ; 2016.
Descripteurs français
- KwdFr :
- Acide lactique (sang), Choc septique (), Choc septique (diagnostic), Choc septique (mortalité), Consensus, Courbe ROC, Enfant, Enfant d'âge préscolaire, Enquêtes et questionnaires, Europe, Femelle, Humains, Indice de gravité médicale, Mâle, Méthode Delphi, Nourrisson, Statistique non paramétrique, Terminologie comme sujet, Unités de soins intensifs pédiatriques, Vasoconstricteurs (usage thérapeutique), Études rétrospectives.
- MESH :
- diagnostic : Choc septique.
- mortalité : Choc septique.
- sang : Acide lactique.
- usage thérapeutique : Vasoconstricteurs.
- Choc septique, Consensus, Courbe ROC, Enfant, Enfant d'âge préscolaire, Enquêtes et questionnaires, Europe, Femelle, Humains, Indice de gravité médicale, Mâle, Méthode Delphi, Nourrisson, Statistique non paramétrique, Terminologie comme sujet, Unités de soins intensifs pédiatriques, Études rétrospectives.
English descriptors
- KwdEn :
- Child, Child, Preschool, Consensus, Delphi Technique, Europe, Female, Humans, Infant, Intensive Care Units, Pediatric, Lactic Acid (blood), Male, ROC Curve, Retrospective Studies, Severity of Illness Index, Shock, Septic (diagnosis), Shock, Septic (mortality), Shock, Septic (therapy), Statistics, Nonparametric, Surveys and Questionnaires, Terminology as Topic, Vasoconstrictor Agents (therapeutic use).
- MESH :
- chemical , blood : Lactic Acid.
- diagnosis : Shock, Septic.
- mortality : Shock, Septic.
- chemical , therapeutic use : Vasoconstrictor Agents.
- therapy : Shock, Septic.
- Child, Child, Preschool, Consensus, Delphi Technique, Europe, Female, Humans, Infant, Intensive Care Units, Pediatric, Male, ROC Curve, Retrospective Studies, Severity of Illness Index, Statistics, Nonparametric, Surveys and Questionnaires, Terminology as Topic.
Abstract
Although overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and neonatal intensive care (ESPNIC) experts’ definition of paediatric RSS.
We conducted a two-round Delphi study followed by an observational multicentre retrospective study. One hundred and fourteen paediatric intensivists answered a clinical case-based, two-round Delphi survey, identifying clinical items consistent with RSS. Multivariate analysis of these items in a development single-centre cohort (70 patients, 30 % mortality) facilitated development of RSS definitions based on either a bedside or computed severity score. Both scores were subsequently tested in a validation cohort (six centres, 424 patients, 11.6 % mortality).
From the Delphi process, the draft definition included evidence of myocardial dysfunction and high blood lactate levels despite high vasopressor treatment. When assessed in the development population, each item was independently associated with the need for extracorporeal life support (ECLS) or death. Resultant bedside and computed septic shock scores had high discriminative power against the need for ECLS or death, with areas under the receiver operating characteristics curve of 0.920 (95 % CI 0.89–0.94), and 0.956 (95 % CI 0.93–0.97), respectively. RSS defined by a bedside score equal to or higher than 2 and a computed score equal to or higher than 3.5 was associated with a significant increase in mortality.
This ESPNIC definition of RSS accurately identifies children with the most severe form of septic shock.
The online version of this article (doi:10.1007/s00134-016-4574-2) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1007/s00134-016-4574-2
PubMed: 27709263
PubMed Central: 5106490
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type="city">Melbourne</settlement></placeName><orgName type="university">Université de Melbourne</orgName></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff13">Cardiothoracic Intensive Care Unit, National University Health System, Singapore, Singapore</nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Cardiothoracic Intensive Care Unit, National University Health System, Singapore</wicri:regionArea><wicri:noRegion>Singapore</wicri:noRegion></affiliation></author><author><name sortKey="Tissieres, Pierre" sort="Tissieres, Pierre" uniqKey="Tissieres P" first="Pierre" last="Tissieres">Pierre Tissieres</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Paediatric Intensive Care Unit, Paris South University Hospitals, AP-HP, 78 Rue du General Leclerc, 94275 Le Kremlin-Bicêtre, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Paediatric Intensive Care Unit, Paris South University Hospitals, AP-HP, 78 Rue du General Leclerc, 94275 Le 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type="main">Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition</title><author><name sortKey="Morin, Luc" sort="Morin, Luc" uniqKey="Morin L" first="Luc" last="Morin">Luc Morin</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Paediatric Intensive Care Unit, Paris South University Hospitals, AP-HP, 78 Rue du General Leclerc, 94275 Le Kremlin-Bicêtre, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Paediatric Intensive Care Unit, Paris South University Hospitals, AP-HP, 78 Rue du General Leclerc, 94275 Le Kremlin-Bicêtre</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Le Kremlin-Bicêtre</settlement></placeName></affiliation></author><author><name sortKey="Ray, Samiran" sort="Ray, Samiran" uniqKey="Ray S" first="Samiran" last="Ray">Samiran Ray</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Wilson, Clare" sort="Wilson, Clare" uniqKey="Wilson C" first="Clare" last="Wilson">Clare Wilson</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Paediatric Intensive Care Unit, Saint-Mary’s Hospital, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Paediatric Intensive Care Unit, Saint-Mary’s Hospital, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Remy, Solenn" sort="Remy, Solenn" uniqKey="Remy S" first="Solenn" last="Remy">Solenn Remy</name><affiliation wicri:level="1"><nlm:aff id="Aff4">Paediatric Intensive Care Unit, Lyon University Hospitals, Bron, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Paediatric Intensive Care Unit, Lyon University Hospitals, Bron</wicri:regionArea><wicri:noRegion>Bron</wicri:noRegion><wicri:noRegion>Bron</wicri:noRegion></affiliation></author><author><name sortKey="Benissa, Mohamed Rida" sort="Benissa, Mohamed Rida" uniqKey="Benissa M" first="Mohamed Rida" last="Benissa">Mohamed Rida Benissa</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Paediatric Intensive Care Unit, Paris South University Hospitals, AP-HP, 78 Rue du General Leclerc, 94275 Le Kremlin-Bicêtre, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Paediatric Intensive Care Unit, Paris South University Hospitals, AP-HP, 78 Rue du General Leclerc, 94275 Le Kremlin-Bicêtre</wicri:regionArea><wicri:noRegion>94275 Le Kremlin-Bicêtre</wicri:noRegion><wicri:noRegion>94275 Le Kremlin-Bicêtre</wicri:noRegion></affiliation></author><author><name sortKey="Jansen, Nicolaas J G" sort="Jansen, Nicolaas J G" uniqKey="Jansen N" first="Nicolaas J. G." last="Jansen">Nicolaas J. G. Jansen</name><affiliation wicri:level="3"><nlm:aff id="Aff5">Paediatric Intensive Care Unit, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Paediatric Intensive Care Unit, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht</wicri:regionArea><placeName><settlement type="city">Utrecht</settlement><region nuts="2" type="province">Utrecht (province)</region></placeName></affiliation></author><author><name sortKey="Javouhey, Etienne" sort="Javouhey, Etienne" uniqKey="Javouhey E" first="Etienne" last="Javouhey">Etienne Javouhey</name><affiliation wicri:level="1"><nlm:aff id="Aff4">Paediatric Intensive Care Unit, Lyon University Hospitals, Bron, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Paediatric Intensive Care Unit, Lyon University Hospitals, Bron</wicri:regionArea><wicri:noRegion>Bron</wicri:noRegion><wicri:noRegion>Bron</wicri:noRegion></affiliation></author><author><name sortKey="Peters, Mark J" sort="Peters, Mark J" uniqKey="Peters M" first="Mark J." last="Peters">Mark J. Peters</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Kneyber, Martin" sort="Kneyber, Martin" uniqKey="Kneyber M" first="Martin" last="Kneyber">Martin Kneyber</name><affiliation wicri:level="3"><nlm:aff id="Aff6">Paediatric Intensive Care Unit, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Paediatric Intensive Care Unit, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation><affiliation wicri:level="4"><nlm:aff id="Aff7">Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), The University of Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), The University of Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region><settlement type="city">Groningue (ville)</settlement></placeName><orgName type="university">Université de Groningue</orgName></affiliation></author><author><name sortKey="De Luca, Daniele" sort="De Luca, Daniele" uniqKey="De Luca D" first="Daniele" last="De Luca">Daniele De Luca</name><affiliation wicri:level="1"><nlm:aff id="Aff8">Neonatal Intensive Care Unit, Paris South University Hospitals, AP-HP, Clamart, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Neonatal Intensive Care Unit, Paris South University Hospitals, AP-HP, Clamart</wicri:regionArea><wicri:noRegion>Clamart</wicri:noRegion><wicri:noRegion>Clamart</wicri:noRegion></affiliation></author><author><name sortKey="Nadel, Simon" sort="Nadel, Simon" uniqKey="Nadel S" first="Simon" last="Nadel">Simon Nadel</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Paediatric Intensive Care Unit, Saint-Mary’s Hospital, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Paediatric Intensive Care Unit, Saint-Mary’s Hospital, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Schlapbach, Luregn Jan" sort="Schlapbach, Luregn Jan" uniqKey="Schlapbach L" first="Luregn Jan" last="Schlapbach">Luregn Jan Schlapbach</name><affiliation wicri:level="1"><nlm:aff id="Aff9">Paediatric Intensive Care Unit, Lady Cilento Children’s Hospital, Children’s Health Queensland, Brisbane, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Paediatric Intensive Care Unit, Lady Cilento Children’s Hospital, Children’s Health Queensland, Brisbane</wicri:regionArea><wicri:noRegion>Brisbane</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff10">Paediatric Critical Care Research Group, Mater Research, The University of Queensland, Brisbane, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Paediatric Critical Care Research Group, Mater Research, The University of Queensland, Brisbane</wicri:regionArea><wicri:noRegion>Brisbane</wicri:noRegion></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff11">Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName></affiliation></author><author><name sortKey="Maclaren, Graeme" sort="Maclaren, Graeme" uniqKey="Maclaren G" first="Graeme" last="Maclaren">Graeme Maclaren</name><affiliation wicri:level="4"><nlm:aff id="Aff12">Department of Paediatrics, Royal Children’s Hospital, University of Melbourne, Melbourne, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Paediatrics, Royal Children’s Hospital, University of Melbourne, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region><settlement type="city">Melbourne</settlement></placeName><orgName type="university">Université de Melbourne</orgName></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff13">Cardiothoracic Intensive Care Unit, National University Health System, Singapore, Singapore</nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Cardiothoracic Intensive Care Unit, National University Health System, Singapore</wicri:regionArea><wicri:noRegion>Singapore</wicri:noRegion></affiliation></author><author><name sortKey="Tissieres, Pierre" sort="Tissieres, Pierre" uniqKey="Tissieres P" first="Pierre" last="Tissieres">Pierre Tissieres</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Paediatric Intensive Care Unit, Paris South University Hospitals, AP-HP, 78 Rue du General Leclerc, 94275 Le Kremlin-Bicêtre, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Paediatric Intensive Care Unit, Paris South University Hospitals, AP-HP, 78 Rue du General Leclerc, 94275 Le Kremlin-Bicêtre</wicri:regionArea><wicri:noRegion>94275 Le Kremlin-Bicêtre</wicri:noRegion><wicri:noRegion>94275 Le Kremlin-Bicêtre</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff14">Institute of Integrative Biology of the Cell, Paris Saclay University, Saint-Aubin, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Institute of Integrative Biology of the Cell, Paris Saclay University, Saint-Aubin</wicri:regionArea><wicri:noRegion>Saint-Aubin</wicri:noRegion><wicri:noRegion>Saint-Aubin</wicri:noRegion></affiliation></author></analytic><series><title level="j">Intensive Care Medicine</title><idno type="ISSN">0342-4642</idno><idno type="eISSN">1432-1238</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Child</term><term>Child, Preschool</term><term>Consensus</term><term>Delphi Technique</term><term>Europe</term><term>Female</term><term>Humans</term><term>Infant</term><term>Intensive Care Units, Pediatric</term><term>Lactic Acid (blood)</term><term>Male</term><term>ROC Curve</term><term>Retrospective Studies</term><term>Severity of Illness Index</term><term>Shock, Septic (diagnosis)</term><term>Shock, Septic (mortality)</term><term>Shock, Septic (therapy)</term><term>Statistics, Nonparametric</term><term>Surveys and Questionnaires</term><term>Terminology as Topic</term><term>Vasoconstrictor Agents (therapeutic use)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Acide lactique (sang)</term><term>Choc septique ()</term><term>Choc septique (diagnostic)</term><term>Choc septique (mortalité)</term><term>Consensus</term><term>Courbe ROC</term><term>Enfant</term><term>Enfant d'âge préscolaire</term><term>Enquêtes et questionnaires</term><term>Europe</term><term>Femelle</term><term>Humains</term><term>Indice de gravité médicale</term><term>Mâle</term><term>Méthode Delphi</term><term>Nourrisson</term><term>Statistique non paramétrique</term><term>Terminologie comme sujet</term><term>Unités de soins intensifs pédiatriques</term><term>Vasoconstricteurs (usage thérapeutique)</term><term>Études rétrospectives</term></keywords><keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Lactic Acid</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Shock, Septic</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Choc septique</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Shock, Septic</term></keywords><keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Choc septique</term></keywords><keywords scheme="MESH" qualifier="sang" xml:lang="fr"><term>Acide lactique</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Vasoconstrictor Agents</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Shock, Septic</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Vasoconstricteurs</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Child</term><term>Child, Preschool</term><term>Consensus</term><term>Delphi Technique</term><term>Europe</term><term>Female</term><term>Humans</term><term>Infant</term><term>Intensive Care Units, Pediatric</term><term>Male</term><term>ROC Curve</term><term>Retrospective Studies</term><term>Severity of Illness Index</term><term>Statistics, Nonparametric</term><term>Surveys and Questionnaires</term><term>Terminology as Topic</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Choc septique</term><term>Consensus</term><term>Courbe ROC</term><term>Enfant</term><term>Enfant d'âge préscolaire</term><term>Enquêtes et questionnaires</term><term>Europe</term><term>Femelle</term><term>Humains</term><term>Indice de gravité médicale</term><term>Mâle</term><term>Méthode Delphi</term><term>Nourrisson</term><term>Statistique non paramétrique</term><term>Terminologie comme sujet</term><term>Unités de soins intensifs pédiatriques</term><term>Études rétrospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Purpose</title><p>Although overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and neonatal intensive care (ESPNIC) experts’ definition of paediatric RSS.</p></sec><sec><title>Methods</title><p>We conducted a two-round Delphi study followed by an observational multicentre retrospective study. One hundred and fourteen paediatric intensivists answered a clinical case-based, two-round Delphi survey, identifying clinical items consistent with RSS. Multivariate analysis of these items in a development single-centre cohort (70 patients, 30 % mortality) facilitated development of RSS definitions based on either a bedside or computed severity score. Both scores were subsequently tested in a validation cohort (six centres, 424 patients, 11.6 % mortality).</p></sec><sec><title>Results</title><p>From the Delphi process, the draft definition included evidence of myocardial dysfunction and high blood lactate levels despite high vasopressor treatment. When assessed in the development population, each item was independently associated with the need for extracorporeal life support (ECLS) or death. Resultant bedside and computed septic shock scores had high discriminative power against the need for ECLS or death, with areas under the receiver operating characteristics curve of 0.920 (95 % CI 0.89–0.94), and 0.956 (95 % CI 0.93–0.97), respectively. RSS defined by a bedside score equal to or higher than 2 and a computed score equal to or higher than 3.5 was associated with a significant increase in mortality.</p></sec><sec><title>Conclusions</title><p>This ESPNIC definition of RSS accurately identifies children with the most severe form of septic shock.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1007/s00134-016-4574-2) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Liu, L" uniqKey="Liu L">L Liu</name></author><author><name sortKey="Johnson, Hl" uniqKey="Johnson H">HL Johnson</name></author><author><name sortKey="Cousens, S" uniqKey="Cousens S">S Cousens</name></author><author><name sortKey="Perin, J" uniqKey="Perin J">J Perin</name></author><author><name sortKey="Scott, S" uniqKey="Scott S">S Scott</name></author><author><name 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