Observational studyIntensive care medicine2016
Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition.
Observational study in Intensive care medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers, 4 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
52 citing papers in PubMed, 4 syntheses or guidelines pooled it, 111 citations in OpenAlex.
- External validity limitations of randomized trials cited in adult critical care clinical practice guidelines: a systematic review of guidelines published from 2015 to 2020.Frontiers in medicine · 2026Pooled it
- Role of extracorporeal membrane oxygenation in children with sepsis: a systematic review and meta-analysis.Critical care (London, England) · 2020Pooled it
- Methylene Blue for Refractory Shock in Children: A Systematic Review and Survey Practice Analysis.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2020Pooled it
- Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children.Intensive care medicine · 2020Guideline
- Timely administration of antibiotics for neonatal sepsis in the neonatal intensive care unit: A quality improvement initiative.Journal of perinatology : official journal of the California Perinatal Association · 2026Article
- Hemodynamic Assessment in Newborn Infants With Sepsis: A Prospective Observational Study.Cureus · 2026Article
- Article
- Septic Cardiomyopathy: Age-Dependent Physiology and Hemodynamic Aspects-A Narrative Review.Children (Basel, Switzerland) · 2026Review
- Potential biomarkers used for risk estimation of pediatric sepsis-associated organ dysfunction and immune dysregulation.Pediatric research · 2025Review
- Immunomodulation in Pediatric Sepsis: A Narrative Review.Journal of clinical medicine · 2025Review
- Central or Peripheral Venoarterial Extracorporeal Membrane Oxygenation for Pediatric Sepsis: Outcomes Comparison in the Extracorporeal Life Support Organization Dataset, 2000-2021.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2025Article
- Article
- Construction of a novel gene signature linked to ferroptosis in pediatric sepsis.Frontiers in cell and developmental biology · 2025Article
- Hemoadsorption in critically ill neonatal and pediatric patients: a retrospective cohort study from a Latin American tertiary center.Frontiers in medicine · 2025Article
- Use of Speckle-Tracking Echocardiography in Septic Cardiomyopathy in Critically Ill Children: A Narrative Review.Critical care explorations · 2024Review
- Analysis and validation of diagnostic biomarkers and immune cell infiltration characteristics in pediatric sepsis by integrating bioinformatics and machine learning.World journal of pediatrics : WJP · 2023Article
- Extracorporeal Membrane Oxygenation for Septic Shock in Adults and Children: A Narrative Review.Journal of clinical medicine · 2023Review
- A nomogram to predict 28-day mortality in neonates with sepsis: a retrospective study based on the MIMIC-III database.Translational pediatrics · 2023Article
- Harmonizing the Septic Shock Terminology: Need of the Hour.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2023Article
- Transmission of SARS-CoV-2 from mother to fetus or neonate: What to know and what to do?Seminars in fetal & neonatal medicine · 2023Review
Corrections and comments
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Authors and funding
15 authors at 10 institutions in 8 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeAlthough overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and neonatal intensive care (ESPNIC) experts' definition of paediatric RSS.
methodsWe conducted a two-round Delphi study followed by an observational multicentre retrospective study. One hundred and fourteen paediatric intensivists answered a clinical case-based, two-round Delphi survey, identifying clinical items consistent with RSS. Multivariate analysis of these items in a development single-centre cohort (70 patients, 30 % mortality) facilitated development of RSS definitions based on either a bedside or computed severity score. Both scores were subsequently tested in a validation cohort (six centres, 424 patients, 11.6 % mortality).
resultsFrom the Delphi process, the draft definition included evidence of myocardial dysfunction and high blood lactate levels despite high vasopressor treatment. When assessed in the development population, each item was independently associated with the need for extracorporeal life support (ECLS) or death. Resultant bedside and computed septic shock scores had high discriminative power against the need for ECLS or death, with areas under the receiver operating characteristics curve of 0.920 (95 % CI 0.89-0.94), and 0.956 (95 % CI 0.93-0.97), respectively. RSS defined by a bedside score equal to or higher than 2 and a computed score equal to or higher than 3.5 was associated with a significant increase in mortality.
conclusionsThis ESPNIC definition of RSS accurately identifies children with the most severe form of septic shock.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.