Imperial College London
Alternate

ProfessorKathMaitland

Faculty of Medicine, Department of Surgery & Cancer

Professor of Tropical Paediatric Infectious Disease
 
 
 
//

Contact

 

k.maitland CV

 
 
//

Location

 

Based full-time at KEMRI/Wellcome Programme, KenyaQueen Elizabeth and Queen Mary HospitalSt Mary's Campus

//

Summary

 

Publications

Citation

BibTex format

@article{Obonyo:2022:10.1097/PCC.0000000000002968,
author = {Obonyo, N and Olupot-Olupot, P and Mpoya, A and Nteziyaremye, J and Chebet, M and Uyoga, S and Muhindo, R and Fanning, J and Shiino, K and Chan, J and Fraser, JF and Maitland, K},
doi = {10.1097/PCC.0000000000002968},
journal = {Pediatric Critical Care Medicine},
pages = {502--513},
title = {A clinical and physiological prospective observational study on the management of pediatric shock in the post-fluid expansion as supportive therapy trial era},
url = {http://dx.doi.org/10.1097/PCC.0000000000002968},
volume = {23},
year = {2022}
}
Download

RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Objectives: Fluid bolus resuscitation in African children is harmful. Little research has evaluated physiologic effects of maintenance-only fluid strategy.Design: We describe the efficacy of fluid-conservative resuscitation of septic shock using case-fatality, hemodynamic, and myocardial function endpoints.Setting: Pediatric wards of Mbale Regional Referral Hospital, Uganda, and Kilifi County Hospital, Kenya, conducted between October 2013 and July 2015. Data were analysed from August 2016 to July 2019.Patients: Children (≥ 60 d to ≤ 12 yr) with severe febrile illness and clinical signs of impaired perfusion.Interventions: IV maintenance fluid (4 mL/kg/hr) unless children had World Health Organization (WHO) defined shock (≥ 3 signs) where they received two fluid boluses (20 mL/kg) and transfusion if shock persisted. Clinical, electrocardiographic, echocardiographic, and laboratory data were collected at presentation, during resuscitation and on day 28. Outcome measures were 48-hour mortality, normalization of hemodynamics, and cardiac biomarkers.Measurement and Main Results: Thirty children (70% males) were recruited, six had WHO shock, all of whom died (6/6) versus three of 24 deaths in the non-WHO shock. Median fluid volume received by survivors and nonsurvivors were similar (13 [interquartile range (IQR), 9–32] vs 30 mL/kg [28–61 mL/kg], z = 1.62, p = 0.23). By 24 hours, we observed increases in median (IQR) stroke volume index (39 mL/m2 [32–42 mL/m2] to 47 mL/m2 [41–49 mL/m2]) and a measure of systolic function: fractional shortening from 30 (27–33) to 34 (31–38) from baseline including children managed with no-bolus. Children with WHO shock had a higher mean level of cardiac troponin (t = 3.58; 95% CI, 1.24–1.43; p = 0.02) and alpha-atrial natriuretic peptide (t = 16.5; 95% CI, 2.80–67.5; p < 0.01) at admission compared with non-WHO shock. Elevate
AU  - Obonyo,N
AU  - Olupot-Olupot,P
AU  - Mpoya,A
AU  - Nteziyaremye,J
AU  - Chebet,M
AU  - Uyoga,S
AU  - Muhindo,R
AU  - Fanning,J
AU  - Shiino,K
AU  - Chan,J
AU  - Fraser,JF
AU  - Maitland,K
DO  - 10.1097/PCC.0000000000002968
EP  - 513
PY  - 2022///
SN  - 1529-7535
SP  - 502
TI  - A clinical and physiological prospective observational study on the management of pediatric shock in the post-fluid expansion as supportive therapy trial era
T2  - Pediatric Critical Care Medicine
UR  - http://dx.doi.org/10.1097/PCC.0000000000002968
UR  - https://journals.lww.com/pccmjournal/Fulltext/2022/07000/A_Clinical_and_Physiological_Prospective.4.aspx
UR  - http://hdl.handle.net/10044/1/96637
VL  - 23
ER  -
Download