A Survey of Stated Physician Practices and Beliefs on the Use of Steroids in Pediatric Fluid and/or Vasoactive Infusion-Dependent Shock

作者：Menon Kusum^*; McNally James D; Choong Karen; Ward Roxanne E; Lawson Margaret L; Ramsay Tim; Wong Hector R

来源：Pediatric Critical Care Medicine, 2013, 14(5): 462-466.

DOI：10.1097/PCC.0b013e31828a7287

• adrenal insufficiency
• pediatric critical care
• pediatric intensive care
• septic shock
• shock
• steroids

Objective: %26lt;br%26gt;Limited evidence exists on the use of corticosteroids in pediatric shock. We sought to determine physicians%26apos; practices and beliefs with regard to the management of pediatric shock. %26lt;br%26gt;Design: %26lt;br%26gt;Cross-sectional, Internet-based survey. %26lt;br%26gt;Setting: %26lt;br%26gt;Canada. %26lt;br%26gt;Subjects: %26lt;br%26gt;Physicians identified as practicing pediatric intensive care in any of 15 academic centers. %26lt;br%26gt;Measurements and Main Results: %26lt;br%26gt;Seventy of 97 physicians (72.2%) responded. Physicians stated that they were more likely to prescribe steroids for septic shock than for shock following cardiac surgery (odds ratio, 1.9 [95% CI, 0.9-4.3]) or trauma (odds ratio, 11.46 [95% CI, 2.5-51.2]), and 91.4% (64/70) would administer steroids to patients who had received 60 cc/kg of fluid and two or more vasoactive medications. Thirty-five percent of respondents (25/70) reported that they rarely or never conducted adrenal axis testing before giving steroids to patients in shock. Eighty-seven percent of respondents (61/70) stated that the role of steroids in the treatment of fluid and/or vasoactive drug-dependent shock needed to be clarified and that 84.3% would be willing to randomize patients into a trial of steroid efficacy who were fluid resuscitated and on one high-dose vasoactive medication. However, 74.3% stated that they would start open-label steroids in patients who required two high-dose vasoactive medications. %26lt;br%26gt;Conclusions: %26lt;br%26gt;This survey provides information on the stated beliefs and practices of pediatric critical care physicians with regard to the use of steroids in fluid and/or vasoactive drug-dependent shock. Clinicians feel that the role of steroids in shock still requires clarification and that they would be willing to randomize patients into a trial. This survey may be useful as an initial framework for the development of a future trial on the use of steroids in pediatric shock.

• 出版日期2013-6