Early inotropic support without fluid bolus vs standard resuscitation in pediatric septic shock: A randomized controlled trial

doi:10.5409/wjcp.v15.i1.109864

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World Journal of Clinical Pediatrics

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2219-2808

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Randomized Controlled Trial

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World J Clin Pediatr. Mar 9, 2026; 15(1): 109864
Published online Mar 9, 2026. doi: 10.5409/wjcp.v15.i1.109864

Table 1 Baseline characteristics of the patients

	Group I (n = 24)	Group F (n = 25)	P value
	mean (± SD), median (IQR)	mean (± SD), median (IQR)	P value
Age, years	6.5 (1.0-11.0)	6.0 (1.13-11.0)	0.936
Sex, males	15 (62.5)	18 (72.0)	0.551
Duration of illness, days	6.5 (4.0-14.5)	5.0 (4.0-10.0)	0.402
Weight, kg	17.4 (12.1)	15.9 (9.8)	0.795
Height, cm	101.7 (40.7)	102.3 (29.7)	0.826
HR, per min	139 (27.6)	154 (30.8)	0.076
RR, per min	45 (19.4)	48 (20.9)	0.837
SBP	NR-3; 83.71 (16.9)	NR-6; 78.90 (14.7)	0.346
DBP	NR-3; 38.30 (12.4)	NR-7; 38.00 (15.4)	0.941
MAP	NR-3; 53.50 (11.1)	NR-7; 51.60 (13.6)	0.642
Systolic shock index = HR/SBP	n = 20; 1.8 (0.58)	n = 20; 1.8 (0.50)	0.599
Diastolic shock index = HR/DBP	n = 21; 3.976 (1.543)	n = 18; 4.612 (2.066)	0.278
IVC collapsibility index	31.70 (22.30-39.75)	34.00 (25.95-56.28)	0.190
Fever	19/24 (79.2)	20/25 (80.0)	1.000
GCS	14.50 (4.25-15.00)	13.00 (7.00-15.00)	0.916
Underlying comorbidity	12/24 (50.0)	11/25 (44.0)	0.778
Received prior intravenous antibiotics	13/24 (54.2)	10/25 (40.0)	0.396
Warm shock; cold shock	13/24 (54.2); 11/24 (45.8)	8/25 (32.0); 17/25 (68.0)	0.154
Compensated shock	8/24 (33.3)	8/25 (32.0)	1.000
Hypotensive shock	16/24 (66.7)	17/25 (68.0)	1.000
Hypoglycemia	3/24 (12.5)	2/25 (8.0)	0.667
Focus of infection			0.111
Blood stream	0/24 (0)	2/25 (8.0)
Respiratory	5/24 (20.8)	9/25 (36.0)
Abdomen	3/24 (12.5)	3/25 (12.0)
CNS	5/24 (20.8)	6/25 (24.0)
Joints/bones	2/24 (8.3)	0/25 (0)
Renal	0/24 (0)	3/25 (12.0)
Skin	4/24 (16.7)	1/25 (4.0)
Disseminated	5/24 (20.8)	1/25 (4.0)
pSOFA-L score	12.0 (3.9)	11.56 (3.7)	0.687

CNS: Central nervous system; DBP: Diastolic blood pressure; GCS: Glasgow Coma Scale; HR: Heart rate; IVC: Inferior vena cava; MAP: Mean arterial pressure; pSOFA-L score: Pediatric Sequential Organ Failure Assessment- Lactate score; RR: Respiratory rate; SBP: Systolic blood pressure; IQR: Interquartile range; Group I: Group receiving early inotropes without giving fluid bolus; Group F: Group receiving fluid resuscitation; NR-3: Not recordable (3 patients); NR-6: Not recordable (6 patients); NR-7: Not recordable (7 patients).

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Table 2 Baseline laboratory parameters

	Group I (n = 24)	Group F (n = 25)	P value
	mean (SD), median (IQR)	mean (SD), median (IQR)
pH	7.33 (7.17-7.43)	7.26 (7.13-7.37)	0.211
pCO₂, mm Hg	28.3 (25.9-34.4)	26.3 (21.7-31.6)	0.140
Bicarbonate, mEq/L	15.67 (6.44)	13.47 (6.44)	0.238
Base deficit, mEq/L	10.5 (6.2-13.3)	12.7 (8.3-17.7)	0.052
Lactate, mmol/L	3.83 (2.53-6.42)	4.38 (2.55-9.33)	0.696
Hemoglobin, gm/dL	9.32 (1.66)	9.04 (2.45)	0.647
Platelet, counts/mL	94000 (42250-261500)	140000 (32500-242000)	0.984
TLC, counts/mL	20900 (16004)	14867 (11514)	0.135
ANC, counts/mL	9750 (4425-23975)	8400 (3240-14670)	0.250
Sodium, mEq/L	137 (133-148)	136 (133-143)	0.920
Potassium, mEq/L	4.20 (3.80-5.53)	4.10 (3.60-5.05)	0.589
Chloride, mEq/L	103.5 (97.0-111.8)	103.0 (100.5-108.0)	0.802
Urea, mg/dL	49.00 (24.25-92.00)	44.00 (26.50-97.50)	0.968
Creatinine, mg/dL	0.78 (0.46-1.43)	0.82 (0.59-2.19)	0.490
Uric acid, mg/dL	5.55 (3.47-11.87)	6.10 (4.05-10.00)	0.904
PT, seconds	13.50 (11.82-25.00)	13.20 (12.20-17.50)	0.849
INR	1.30 (1.10-2.28)	1.20 (1.10-1.60)	0.672
aPTT, seconds	34.20 (31.40-60.15)	39.00 (29.75-50.50)	0.936
Total bilirubin, mg/dL	0.94 (0.42-1.98)	0.74 (0.52-1.28)	0.379
Direct bilirubin, mg/dL	0.36 (0.14-0.81)	0.21 (0.10-0.62)	0.267
Indirect bilirubin, mg/dL	0.43 (0.30-1.47)	0.45 (0.32-0.75)	0.749
AST, U/L	97.00 (45.25-455.00)	69.00 (38.00-134.00)	0.254
ALT, U/L	79.00 (29.25-151.00)	43.00 (16.50-105.00)	0.144
ALP, U/L	187.5 (116.5- 272.5)	158.0 (96.0-275.0)	0.368
GGT, U/L	66.5 (33.5-142.5)	43.0 (17.0-89.5)	0.093
Total protein, g/dL	5.30 (1.18)	5.29 (1.18)	0.976
Albumin, g/dL	2.50 (0.63)	2.79 (0.79)	0.277
Globulin, g/dL	2.76 (0.98)	2.42 (0.73)	0.242
CRP, mg/dL	80.00 (33.48-159.97)	80.00 (37.06-154.36)	1.000

ANC: Absolute neutrophil count; ALP: Alkaline phosphatase; ALT: Alanine aminotransferase; AST: Alanine aminotransferase; CRP: C-reactive protein; GGT: Gamma-glutamyl transferase; pCO₂: Partial pressure of carbon dioxide; TLC: Total leucocyte count; IQR: Interquartile range; Group I: Group receiving early inotropes without giving fluid bolus; Group F: Group receiving fluid resuscitation; PT: Prothrombin time; INR: International normalised ratio; aPTT: Activated partial thromboplastin time.

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Table 3 Organisms isolated

Organism	Number of patients
Methicillin sensitive Staphylococcus aureus	6
Scrub typhus	5
Escherichia coli	5
Methicillin resistant Staphylococcus aureus	2
Coagulase-negative Staphylococci	2
Plasmodium falciparum	1
Pseudomonas aeruginosa	1
Klebsiella pneumoniae	1
Proteus mirabilis	1
Morganella morganii	1
Candida albicans	1
Total	26

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Table 4 Multiregression analysis of various parameters to predict the final outcome

	Unstandardized B	t	Sig
Constant	1.609	2.775	0.009
Intervention group	-0.790	-0.509	0.614
Underlying comorbidity	-0.207	-1.375	0.180
Diastolic shock index	-0.065	-1.636	0.112
Ventilatory requirement	0.082	0.813	0.423
Compensated vs hypotensive shock	-0.150	-0.981	0.335
Signs of fluid overload	-0.130	-0.840	0.408
Maximum VIS score	0.003	2.074	0.047
pSOFA-L score	0.047	2.349	0.026

VIS: Vasoactive inotropic support; pSOFA-L score: Pediatric Sequential Organ Failure Assessment- Lactate score.

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Table 5 Subgroup analysis of patients with compensated shock and hypotensive shock

Parameters	Patients with compensated shock (n = 16)				Patients with hypotensive shock (n = 33)
Parameters	Group I-1 (n = 8)	Group F-1 (n = 8)	P value	Group I-2 (n = 16)		Group F-2 (n = 17)	P value
Patients who had resolution of shock	8/8 (100)	8/8 (100)	1	16/16 (100)		11/17 (64.70)	0.018
Time of resolution of shock, minutes	80.63 (25.05)	125.63 (54.34)	0.052	85.66 (49.04)		110.23 (30.81), n = 11	0.154
VIS for resolution of shock	30.00 (13.09)	21.25 (9.90)	0.161	31.56 (15.02)		42.73 (32.59), n = 11	0.24
Mean fluid required within 6 h, mL/kg	0 (0), n = 0	27.50 (8.86)		28.00 (11.80), n = 5		31.76 (13.80)
Signs of fluid overload	0/8 (0)	4/8 (50.00)		1/16 (6.25)		12/17 (70.00)	0
Duration of inotropes, hours	68.00 (36.00-111.75)	70.50 (17.36-102.00)	0.574	113.52 (88.70)		37.82 (34.62)	0.003
Duration of ventilation, hours	109.00 (37.25-138.00), n = 4	50.00 (13.00-222.00), n = 5	0.556	76.00 (18.00-144.00), n = 11		22.50 (10.00-85.50), n = 14	0.222
Length of hospital stay, days	11.00 (4.06-20.00)	12.00 (7.25-22.50)	0.574	9.50 (3.88-23.50)		1.58 (0.89-15.00)	0.094
Maximum VIS during hospital stay	48.75 (36.82)	42.50 (37.70)	0.742	85.31 (48.35)		103.53 (70.71)	0.397
Mortality at 48 h	1/8 (12.50)	0/8 (0)		3/16 (18.75)		9/17 (52.94)	0.041
Discharge; death	4 (50.00); 4 (50.00)	6 (75.00); 2 (25.00)	0.608	8 (50.00); 8 (50.00)		7 (41.20); 10 (58.80)	0.732

VIS: Vasoactive inotropic support; Group I: Group receiving early inotropes without giving fluid bolus; Group F: Group receiving fluid resuscitation.

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Citation: Keshri S, Goel AK, Garg AK, Anand V, Rathia SK, Yusuf S. Early inotropic support without fluid bolus vs standard resuscitation in pediatric septic shock: A randomized controlled trial. World J Clin Pediatr 2026; 15(1): 109864
URL: https://www.wjgnet.com/2219-2808/full/v15/i1/109864.htm
DOI: https://dx.doi.org/10.5409/wjcp.v15.i1.109864