패혈증 및 패혈성 쇼크로 진단 받은 소아 중환자에서 vitamin protocol의 효과 비교
The Effect of the Vitamin Protocol for Treating Sepsis or Septic Shock in Pediatric Intensive Care Unit
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Background: Recently, a study comprising adult patients with sepsis admitted in the intensive care unit (ICU) was conducted. The patients were treated with high doses of intravenous ascorbic acid, thiamine, and hydrocortisone; the clinical outcomes demonstrated significant therapeutic benefits. The mortality rate in children with sepsis is approximately 25%. However, the effects of additional treatment with ascorbic acid and thiamine (“vitamin protocol”) in children are rarely investigated. Methods: A retrospective analysis was performed using medical records of patients diagnosed with sepsis and admitted to the pediatric ICU (PICU) between September 2016 and June 2019. The control group received treatment only as per sepsis protocol, whereas the treated group received both sepsis protocol and the vitamin protocol. The primary endpoint was change in Vasoactive-Inotropic Score (VIS) for 5 days. The secondary endpoints included the length of stay in the PICU, duration of using mechanical ventilators and vasopressors, and mortality rate. Results: The number of patients in the treated and control groups was 33 and 24, respectively. The treated group showed greater decrease in their VIS for 5 days than the control group (44.4 vs 18.6); however, the difference was not statistically significant. The length of stay in the PICU was significantly longer for the treated group than for the control group [10.0 days (Interquartile range (IQR), 6-18) vs 4.5 days (IQR, 4-10.3); p=0.004]. Conclusions: No significant treatment benefits were observed following vitamin protocol administration to the pediatric patients with sepsis. Further studies are necessary for improving the efficacy and safety of the vitamin protocol.
Abstract
Background: Recently, a study comprising adult patients with sepsis admitted in the intensive care unit (ICU) was conducted. The patients were treated with high doses of intravenous ascorbic acid, thiamine, and hydrocortisone; the clinical outcomes demonstrated significant therapeutic benefits. The mortality rate in children with sepsis is approximately 25%. However, the effects of additional treatment with ascorbic acid and thiamine (“vitamin protocol”) in children are rarely investigated. Methods: A retrospective analysis was performed using medical records of patients diagnosed with sepsis and admitted to the pediatric ICU (PICU) between September 2016 and June 2019. The control group received treatment only as per sepsis protocol, whereas the treated group received both sepsis protocol and the vitamin protocol. The primary endpoint was change in Vasoactive-Inotropic Score (VIS) for 5 days. The secondary endpoints included the length of stay in the PICU, duration of using mechanical ventilators and vasopressors, and mortality rate. Results: The number of patients in the treated and control groups was 33 and 24, respectively. The treated group showed greater decrease in their VIS for 5 days than the control group (44.4 vs 18.6); however, the difference was not statistically significant. The length of stay in the PICU was significantly longer for the treated group than for the control group [10.0 days (Interquartile range (IQR), 6-18) vs 4.5 days (IQR, 4-10.3); p=0.004]. Conclusions: No significant treatment benefits were observed following vitamin protocol administration to the pediatric patients with sepsis. Further studies are necessary for improving the efficacy and safety of the vitamin protocol.
참고문헌 (24)
- Levy MM, "The surviving sepsis campaign bundle : 2018 update", Intensive Care Med, 44(6), pp.925~928 (2018)
- Weiss SL, "Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children", Intensive Care Med, 46(Suppl 1), pp.10~67 (2020)
- Fleischmann C, "Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations", Am J Respir Crit Care Med, 193(3), pp.259~272 (2016)
- Fleischmann-Struzek C, "The global burden of paediatric and neonatal sepsis : a systematic review", Lancet Respir Med, 6(3), pp.223~230 (2018)
- Tan B, "Global case-fatality rates in pediatric severe sepsis and septic shock : a systematic review and meta-analysis", JAMA Pediatr, 173(4), pp.352~362 (2019)
- Marik PE, "Hydrocortisone, vitamin C, and thiamine for the treatment of severe sepsis and septic shock: A retrospective before-after study", Chest, 151(6), pp.1229~1238 (2017)
- Moskowitz A, "Ascorbic acid, corticosteroids, and thiamine in sepsis: a review of the biologic rationale and the present state of clinical evaluation", Crit Care, 22(1), pp.283~ (2018)
- Amrein K, "Vitamin therapy in critically ill patients:focus on thiamine, vitamin C, and vitamin D", Intensive Care Med, 44, pp.1940~1944 (2018)
- Fowler AA 3rd, "Phase 1 safety trial of intravenous ascorbic acid in patients with severe sepsis", J Transl Med, 12, pp.32~ (2014)
- Zabet MH, "Effect of highdose ascorbic acid on vasopressor’s requirement in septic shock", J Res Pharm Pract, 5(2), pp.94~100 (2016)
- Shin TG, "Early vitamin C and thiamine administration to patients with septic shock in emergency departments : Propensitiy score-based analysis of a before-and-after cohort study", J Clin Med, 8(1), pp.102~ (2019)
- Fowler AA 3rd, "Effect of vitamin C infusion on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure; The CITRIS-ALI randomized clinical trial", JAMA, 322(13), pp.1261~1270 (2019)
- von Dessauer B, "Oxidative stress as a novel target in pediatric sepsis management", J Crit Care, 26(1), pp.103~ (2011)
- Nathens AB, "Randomized, prospective trial of antioxidant supplementation in critically ill surgical patients", Ann Surg, 236(6), pp.814~822 (2002)
- Lima LF, "Low blood thiamine concentrations in children upon admission to intensive care unit : risk factors and prognostic significance", Am J Clin Nutr, 93(1), pp.57~61 (2011)
- Kim WY, "Combined vitamin C, hydrocortisone, and thiamine therapy for patients with severe pneumonia who were admitted to the intensive care unit: Propensity score-based analysis of a before-after cohort study", J Crit Care, 47, pp.211~218 (2018)
- Almeda A, "High-dose intravenous vitamin C and thiamine as adjuct therapy for septic shock in the pediatric ICU : A case report", Int J Pharmacovigil, 3(2), pp.1~5 (2018)
- Wald EL, "Hydrocortisoneascorbic acid-thiamine use associated with lower mortality in pediatric septic shock", Am J Respir Crit Care Med, 201(7), pp.863~867 (2020)
- Rhodes A, "Surviving sepsis campaign:international guidelines for management of sepsis and septic shock:2016", 43(3), pp.304~377 (2017)
- Haque A, "Association between vasoactive-inotropic score and mortality in pediatric septic shock", Indian Pediatr, 52(4), pp.311~313 (2015)
- McIntosh AM, "Validation of the vasoactive-inotropic score in pediatric sepsis", Pediatr Crit Care Med, 18(8), pp.750~757 (2017)
- 이상훈, "응급실 소아 손상 환자의 중증도 예측을 위한 PRISM III의 유용성", 대한응급의학회지, 24(2), pp.174~180 (2013), 대한응급의학회
- Colliou E, "Oxalate nephropathy following vitamin C intake within intensive care unit", Clin Nephrol, 88(12), pp.354~358 (2017)
- Michelle Buehner, "Oxalate nephropathy after continuous infusion of high-dose vitamin C as an adjunct to burn resuscitation", J Burn Care Res, 37, pp.e374~e379 (2016)