Clinical study of volume resuscitation in children with septic shock / 中华危重病急救医学

ABSTRACT

Objective To compare the effect of crystalloid and crystalloid plus albumin in the treatment of pediatric septic shock.Methods Data of 63 pediatric patients with septic shock admitted to Department of Critical Care Medicine of Hebei Provincial Children's Hospital were collected and retrospectively analyzed.The patients were divided into two groups according to whether they received albumin for volume resuscitation within 1 day after admission or not.The patients in observation group (crystalloid + albumin group,n =33) received normal saline (20 mL/kg) followed by 1 g/kg albumin 30 minutes after admission,and those in control group (crystalloid group,n =30) received only normal saline (20 mL/kg) 30 minutes after admission,and normal saline resuscitation was continued according to the effect of fluid therapy.Anti-infection and vasoactive drugs strategies were the same in both groups.The first-hour infusion volume,time showing stable hemodynamics,the incidence of pulmonary edema,and blood lactate levels at 0,6,12 hours after achieving the goals were compared,and blood lactate clearance rates were calculated.Results The first-hour infusion volume time in the observation group was lower than that in control group (mL41.56 ± 10.50 vs.57.24 ± 7.54,t=4.596,P=0.000),and time showing stable hemodynamics was shorter than that in control group but without statistically significant difference (minutes219.87 ±70.23 vs.287.10 ± 67.00,t=2.047,P=0.360).The incidence of pulmonary edema in observation group was slightly lower than that in control group [6.1％ (2/33) vs.10.0％ (3/30),x2±2.272,P=0.259].The lactic acid levels were decreased gradually along with rehabilitation time,while lactate clearance rate was increased in both groups.At 0 hour and 6 hours after resuscitation,the lactate level (mmol/L) in the observation group was significantly lower than that in control group [0 hour3.65 ± 2.84 vs.5.72 ± 2.11,t＝ 1.940,P=0.046; 6 hours2.12 ± 1.21 vs.4.09 ± 1.45,t=2.892,P=0.005],while the lactate clearance rate was significantly increased compared with control group [0 hour(0.38 ± 0.15)％ vs.(0.18 ± 0.09)％,t=1.447,P=0.018; 6 hours(0.62 ± 0.14)％ vs.(0.51 ± 0.11)％,t=1.920,P=0.047].However,at 12 hours after resuscitation,there were no statistically significant differences in the lactic acid level (mmol/L1.46 ± 0.39 vs.1.54 ± 1.90,t=0.450,P=0.072) and the lactate clearance rate [(0.78 ± 0.19) ％ vs.(0.77 ± 0.18) ％,t =0.091,P=0.928] between observation group and control group.Conclusion Albumin resuscitation in children with septic shock can stabilize hemodynamics earlier,reduce the incidence of pulmonary edema,and improve the successful rescue rate of refractory septic shock.