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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

한국임상약학회지 2020년 30권 3호 p.161 ~ 168
고현정, 정민재, 김재송, 손은선, 유윤미,
소속 상세정보
고현정 ( Ko Hyun-Jung ) - Yonsei University College of Medicine Severance Hospital Department of Pharmacy
정민재 ( Jung Min-Jae ) - Yonsei University College of Medicine Severance Hospital Department of Pharmacy
김재송 ( Kim Jae-Song ) - Yonsei University College of Medicine Severance Hospital Department of Pharmacy
손은선 ( Son Eun-Sun ) - Yonsei University College of Medicine Severance Hospital Department of Pharmacy
유윤미 ( Yu Yun-Mi ) - Yonsei University College of Pharmacy

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.

키워드

Sepsis; septic shock; pediatric; critical care; vitamin protocol

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