Pediatric septic shock and organ dysfunction: Surviving Sepsis Campaign guidelines

  • Weiss SL & al.
  • Pediatr Crit Care Med
  • 1 Feb 2020

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • For children with septic shock and organ dysfunction, resuscitation with starches, inhaled nitric oxide, and aggressive blood glucose management are among the practices discouraged by the Surviving Sepsis Campaign.

Why this matters

  • Sepsis affects 1.2 million children per year.
  • Mortality rates range from 4% to 50%.

Description

  • Evidence-based guidelines covering management of septic shock and sepsis-associated organ dysfunction in children.
  • Includes recommendations, “in our practice” statements, research priorities.

Key details

  • Strong recommendations:
    • For septic shock, begin antimicrobials as early as feasible and within 1 hour.
    • If intravascular access device is confirmed source, remove after establishing other access, weighing risk/benefit of surgery.
    • If intensive care unavailable and patient not hypotensive, avoid bolus fluids.
    • Avoid starches in resuscitation.
    • Avoid routine inhaled nitric oxide in children with pediatric acute respiratory distress syndrome due to sepsis.
    • Avoid insulin targeted at maintaining blood glucose ≤140 mg/dL.
  • Most authors at least sometimes include:
    • Lactate measurement.
    • Dilute vasoactive medication delivery through peripheral line if no other access.
    • Inodilators if persistent hypoperfusion, cardiac dysfunction despite vasoactive medications.
    • Parenteral calcium to target normal levels.
    • Enteral feeding within 48 hours of admission.
    • Intubation of children with refractory shock and without respiratory failure.
    • Blood-glucose target of