Analysis between the relationship of initial therapeutic approach and the clinical evolution of patients with septic shock admitted to pediatric intensive care in a hospital in Managua, Nicaragua (2018-2022)
DOI:
https://doi.org/10.62407/v4narn51Keywords:
Septic shock, pediatric intensive care, resuscitation, fluid overload, medical complicationsAbstract
Objective: To analyze the relationship between initial therapeutic management and clinical outcomes in pediatric patients diagnosed with septic shock admitted to the PICU at Fernando Vélez Paiz Hospital between January 2018 and January 2022. Materials and Methods: A quantitative, observational, correlational, and analytical study with elements of causality and prediction was conducted. The sample included all patients meeting clinical and epidemiological criteria consistent with septic shock. Sociodemographic, clinical, and therapeutic variables, as well as clinical outcomes, were collected. Statistical tools included Spearman’s nonparametric correlation, Fisher’s ANOVA, categorical association tests (Phi and Cramer’s V), survival analysis, and variance models to explore cause-and-effect relationships. Results: Higher fluid volumes administered during the first hour of resuscitation were significantly associated with an increased fluid overload index (p = 0.0001), which in turn correlated with a higher incidence of medical complications (p = 0.0441). No significant association was found between administered volume and total length of hospitalization. Likewise, the timing of vasopressor initiation showed no association with survival (p = 0.575). No relevant associations were identified between the type of infectious focus and key clinical variables such as lactate levels, PICU length of stay, or the need for mechanical ventilation. Conclusion: Initial therapeutic management, particularly fluid administration during resuscitation, directly impacts the occurrence of medical complications, though not survival or hospital stay. These findings reinforce the importance of protocolized hemodynamic management tailored to the pediatric septic shock context, with emphasis on preventing fluid overload as a strategy to reduce complications.
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