1265 Use of Steroids in Inotrope Resistant Sepsis and at Extubation in Uk Paediatric Intensive Care Units - Telephone Audit

Abstract

Aims: Steroids are used in the treatment of severe (inotrope resistant) septic shock and for some paediatric intensive care (PICU) patients at extubation. The aim of this audit is to establish the prescribing practice and protocols used with respect to corticosteroids for paediatric patients at time of extubation or during episodes of severe sepsis in paediatric intensive care units from the UK and Ireland.

Methods: Telephone audit of UK and Irish PICUs undertaken from Mar-Sept 2009 (n=20).

Results: In severe (inotrope resistant) septic shock, 90% (n=18) of units use steroids, all 18 use hydrocortisone, but only 33% (n=6) have a protocol. Dose ranges varied from 1mg/kg 8 hourly to 4mg/kg 6 hourly. Assessment of cortisol (either cortisol level or short synacthen test) is attempted by 67% (n=12) units prior to steroids. Onset and duration of therapy is determined by pragmatic clinical criteria in most units. For extubation, 100% (n=20) use steroids in some circumstances (Dexamethasone 90% [n=18], Dex and Prednisolone & Dex or Prednisolone both 5% [n=1]), with protocols in 30% (n=6) units. First dose varied from 24h pre-extubation to post extubation, dose range (dexamethsone) was 0.1mg/ kg 8 hourly to 0.6mg/kg 6 hourly.

Conclusion: Corticosteroids are used in PICUs in the UK and Ireland for steroid resistant septic shock and extubation. Daily dose can vary by 800% (sepsis) and 533% (extubation), and numerous differing indications for commencing and discontinuing therapy. This data will aid in the design of studies to determine the optimal use of steroids in these conditions.

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