Title

Interhospital Transfer of Children in Septic Shock: A Clinician Interview Qualitative Study.

Document Type

Article

Publication Date

12-1-2018

Identifier

DOI: 10.1177/0885066616683662

Abstract

OBJECTIVE:: To determine the factors that influence the decision to transfer children in septic shock from level II to level I pediatric intensive care unit (PICU) care.

DESIGN:: Interviews with level II PICU physicians in Michigan and Northwest Ohio. A hypothetical scenario of a 14-year-old boy in septic shock was presented.

BASELINE:: 40 mL/kg fluid resuscitation, central venous and peripheral arterial access, and high-dose vasopressor infusions were provided.

ESCALATION POINT:: After 2 hours. When the patient is in catecholamine-resistant shock and oliguric, invasive mechanical ventilation is initiated.

MEASUREMENTS AND MAIN RESULTS:: All 19 eligible physicians participated. At baseline, respondents would assess measures of perfusion and hemodynamics: blood pressure (BP; 15 [79%]), lactate (12 [63%]), and central venous oxygen saturation (ScvO2; 10 [53%]). Poor clinical response was signified by low BP (11 [58%]), elevated lactate (9 [47%]), low urine output (8 [42%]), and low ScvO2(6 [32%]). At the escalation point, 13 of 18 respondents felt there was

CONCLUSIONS:: Level II to level I PICU transfer of children with septic shock is triggered by perceived nonresponse to locally available therapies. Few referring physicians do not transfer children in refractory septic shock. This study provides new insight into decision-making that influences the interhospital transfer of children with septic shock.

Journal Title

Journal of intensive care medicine

Volume

33

Issue

12

First Page

671

Last Page

679

MeSH Keywords

Adolescent; Catheterization, Central Venous; Clinical Decision-Making; Combined Modality Therapy; Extracorporeal Membrane Oxygenation; Fluid Therapy; Humans; Intensive Care Units, Pediatric; Male; Patient Transfer; Qualitative Research; Renal Replacement Therapy; Shock, Septic; Vasoconstrictor Agents

Keywords

critical illness; interhospital transfer; interview; pediatric intensive care; septic shock; therapeutics

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