PP407 Topic: AS14–Infections: Sepsis and Septic Shock/Antimicrobial Stewardship/Tropical and Parasite Infections/Other: A TRIAL TO DETERMINE WHETHER SEPTIC SHOCK REVERSAL IS QUICKER IN PEDIATRIC PATIENTS RANDOMIZED TO AN EARLY GOAL-DIRECTED FLUID-SPARING STRATEGY VS. USUAL CARE (SQUEEZE)
Bibliographic record
Abstract
Aims & Objectives: Fluid bolus therapy has been considered a key component of pediatric septic shock resuscitation. Guidelines have focused on the early and goal-directed administration of intravascular fluid followed by vasoactive medication infusions for fluid-refractory shock. Accumulating evidence has associated excessive fluid administration with worse patient outcomes including death. We sought to determine in pediatric patients with septic shock whether use of a Fluid Sparing strategy results in improved clinical outcomes without an increased risk of adverse events compared to Usual Care. Methods:Design: 2-arm, parallel group, open label, multi-centre randomized controlled trial in 9 Canadian pediatric tertiary care centres. Participants: children 29 days to <18 years of age with a clinical diagnosis of septic shock requiring ongoing resuscitation despite administration of 40 mL/kg (2 litres for >/=50 kg) of isotonic crystalloid or colloid. Sample size target: 400. Interventions: Fluid Sparing or Usual Care strategy. Process: Eligible children were enrolled from the Emergency Department, Hospital Ward, and Pediatric Intensive Care Unit using an ‘exception to consent’ process as approved by site Research Ethics Boards. Primary Outcome: time to shock reversal (hours). Principal Analysis: two-sided t-test (on geometric means). Secondary Outcomes: clinical outcomes and adverse events including measures of organ dysfunction, mortality outcomes, and outcomes related to clinical course and procedures. ClinicalTrials.gov: NCT03080038, NCT01973907. Results: We randomized 406 and following post-randomization exclusions for reasons such as consent decline 392 remained eligible for analysis. Trial results are currently under embargo. Conclusions: CONCLUSIONS: The main results of the multicentre SQUEEZE Trial will inform clinical practice and future research. Keywords: Fluid Therapy, Sepsis, pediatrics, resuscitation, shock
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.016 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".