Lactate kinetics-oriented fluid resuscitation Strategy for lowering the application of catecholamine of septic shock in children

Abstract

Abstract Sepsis is a leading cause of mortality for children wordwide. Some studies suggested that initial hyperlactacidemia and central venous oxygen saturation (ScvO2) are associated with mortality in sepsis. Our objective was to compare whether SCVO2-oriented resuscitation strategies and lactate kinetics oriented resuscitation strategies differ in mortality in children with septic shock. 250 children diagnosed with septic shock between January 2017 and October 2021 were enrolled in this study, and they were randomly assigned to two groups, ScvO2-oriented group (n = 125) and lactate kinetics-oriented group (n = 125). The Trial Registration Number was 20230068 and the date of registration was June 1, 2023. The primary endpoint was the 28-day mortality, and the secondary endpoints included the mechanical ventilation time, 6 h and 12 h success rate of the resuscitation, intensive care unit (ICU) and hospital stay time, the vasoactive inotropic score (VIS) and rate of arrhythmia. There were no significant differences in baseline data and 28-day mortality between the two groups. However, the norepinephrine(NE) dose was lower in the lactate kinetics-oriented group than that in the ScvO2-oriented group at both the 2nd and 3rd day. 6 h success rate of the resuscitation in the lactate kinetics-oriented group was significantly higher than that in the ScvO2 -oriented group (P = 0.037). Conclusions: Compared with the ScvO2-oriented group, the lactate kinetics-oriented group could improve the success rate of the resuscitation in the early stages of septic shock and reduce the application of catecholamine.