Descripción de asociación del tiempo de inicio de reanimación hídrica y desenlaces clínicos en niños con sepsis

Abstract

Sepsis is a problem with high morbidity and mortality. We seek to describe the association between early fluid resuscitation and outcomes of clinical importance in children. DESIGN: Longitudinal Study, secondary analysis of a prospective cohort study. MATERIALS AND METHODS: Children with severe sepsis and septic shock who consulted Fundación Cardio-Infantil’s emergency room from January to November of 2014 were studied. We did and educational intervention to the emergency department staff, and took data before and after this intervention, evaluating start-up time of the fluid resuscitation after sepsis was identified. Bivariated analysis and hierarchical and categorical linear regressions were held to adjust with confounding factors. RESULTS: Of a total of 4383 children who consulted with infectious pathology, 203 patients with severe sepsis and septic shock were included. No differences were observed in sex distribution (50% children) with an average age of 57 months. There were no differences in the PRISM III scale between the groups (p = 0.08). The mean for early initiation of fluid resuscitation was 0 minutes (RIC 0-9) and for late initiation 30 minutes (RIC 8-246) p = 0.004. We found statistically significant differences in the need of initiation of mechanical ventilation in the group where the crystalloid bolus was administrated early, independently of severity (p <0.01). The need for vasoactive agents was independent of the time of initiation of fluid resuscitation adjusted to severity (p = 0.007). We did not find statistically significant associations with duration of mechanical ventilation (p = 0.39), hospital stay (p = 0.48) or need for transfer to intensive care (p = 1). CONCLUSION: Early fluid resuscitation in children with severe sepsis and septic shock, could be associated with a greater need of mechanical ventilation support in seriously ill 9 patients, without affecting other important clinical outcomes. Randomized and controlled studies are needed to corroborate the findings.