Abstract P-561: PEDIATRIC INTENSIVIST DRIVEN DETAILED SYSTEMATISED SERIAL ECHOCARDIOGRAPHY (DSSE) VERSUS ROUTINE ECHOCARDIOGRAPHY IN THE MANAGEMENT OF SEPTIC SHOCK AND ITS OUTCOME

Abstract

Aims & Objectives: To compare death from all causes at 28-days and duration of hospital stay between DSSE and routine echocardiography (RE) group. Methods A prospective open labeled sequential period study among children between 1 month to 12 years of age with septic shock. Children with primary cardiac illness were excluded. Based on the previous year data the estimated sample size was 106 in each group. During the first half of the study, patients were enrolled to the RE group when the echocardiography examinations were done as per the necessity and expertise of the treating team. In the DSSE group a trained pediatric intensivist performed echocardiography at frequent intervals, which included Inferior Vena Cava variation with respiration, left ventricular ejection fraction by modified Simpsons biplane method, LV diastolic dysfunction by mitral E/A ratio and E/E’ and RV dysfunction by tricuspid annulus S’. Results Baseline characteristics and echocardiographic findings are shown in table 1, 2 & 3. Children in the DSSE group had lesser mortality (49.1%) as compared to the RE group (57.7%) with significant difference in Kaplan-Meier survival analysis by Breslow – Generalised Wilcoxon test (p = 0.022). There was no difference in the median length of hospital stay (p=0.68); 12 days (IQR 31, 5) in the DSSE group versus 18 days (IQR 36, 12). In view of the unanticipated low rate of patient enrolment, the power of the study was reduced from 90% to 75% after completion.Conclusions DSSE based management of septic shock improved mortality in children as compared to routine echocardiography based management.