The role of focused echocardiography in optimizing lactate clearance in the first 3 h of pediatric sepsis resuscitation

Abstract

Background: Sepsis causes high morbidity and mortality in pediatric patients globally. Early shock diagnosis and management are important to determine patient survival. Fluid boluses, early inotropic, and vasopressor usage are the keys to improve lactate clearance. Echocardiography helps both determining the type of shock and selecting the hemodynamic therapies. Patients and Methods: A quasi-experimental with one group posttest only design was conducted on 23 pediatric patients who were treated in the resuscitation room of Dr. Soetomo Hospital Surabaya. Patients who met the inclusion and exclusion criteria became the research sample and resuscitated, according to the 1-h sepsis bundle. Patients' hemodynamic status was assessed by echocardiography, and their early blood lactate was checked. Therapies such as fluid adequacy maintenance, cardiac contractility optimization, and vasopressor administration were given according to the type of shock. On the 3 rd h, evaluation of clinical improvement, lactate level, and the posttherapy echocardiography were done. Results: As many as 39% of the patients suffered normotension cold shock, 26% with hypotension cold shock, 9% with normotension warm shock, and the rest 26% with hypotension warm shock. Echocardiographic-guided hemodynamic therapy statistically significantly improved the patient's volume status, contractility, and vascular resistance (P < 0.05). Reversal of shock within the first 3 h, which were derived from clinical improvement and echocardiography measurement, was statistically significantly correlated with >10% lactate clearance (P = 0.001; r = 0.558). Conclusion: Focused echocardiography was effective in evaluating the hemodynamics and lowering the clearance of lactate of pediatric patients with septic shock.