Monitorização hemodinâmica em pacientes pediátricos com sepse e choque séptico: inquérito multicêntrico

Abstract

Sepsis is the main cause of mortality and Pediatric Intensive Care (PICU) admission in children worldwide. International guidelines for septic shock management are not necessarily applicable in low-middle-income countries (LIMC), considering the lack of resources in some settings. The aim of this study is to evaluate the current practices of hemodynamic monitoring in sepsis and septic shock in Brazilian PICUs. It’s a multicenter, cross-sectional study using an electronic survey. Electronic survey was responded in 3 rounds (1 week each) and responses from 77 PICUs in 26 states of Brazil were collected. Point of care cardiac Ultrasound (POCUS) was the method of choice for fluid responsiveness evaluation in septic children in 61% PICUs; 78% PICUs had enough arterial line monitors available to every bed, but only 57% use invasive arterial blood pressure (IBP) monitoring for every patient diagnosed with septic shock; 22% use IBP monitoring just for refractory shock patients. To guide initiation/titration of inotropes and vasoactive agents, 70% PICUs said their decision is based on clinical assessment; 20% use POCUS to aid vasoactive agent’s choice. 88% PICUs use Lactate trend and 35% measure central/mixed venous saturation in patients with septic shock. Differences between what is recommended by international guidelines and what is used in Brazilian PICUs regarding hemodynamic monitoring in pediatric sepsis were identified. These differences may exist for a number of reasons, recognizing them is crucial to making appropriate changes and adjusting valuable guidelines while making them more feasible for LMIC.