In this post I link to the Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Pediatr Crit Care Med. 2020 Feb;21(2):e52-e106.
Here are excerpts:
[What the guidelines cover] from the section KNOWLEDGE GAPS AND RESEARCH OPPORTUNITIES
This report from the SSC pediatric guidelines panel covers
five main topic areas (i.e., early recognition and infection,
hemodynamics, ventilation, endocrine and metabolic therapies, and adjunctive therapies) with a total of 77 recommendations arising from 67 PICO questions. On review of these
evidence-based analyses, it is clear that, for many PICO questions, the literature review failed to identify sufficient data to develop strong (or even weak in some instances) recommendations for critically ill children with septic shock or other sepsis-associated organ dysfunction.Definitions:
In 2005, the International Pediatric Sepsis Consensus Conference published definitions and criteria for sepsis, severe sepsis, and septic shock in children based on prevailing views of adult sepsis at the time with modifications for physiology based on age and maturational considerations (17).
In 2016, new adult definitions and criteria were published (Sepsis-3) with “sepsis” defined as life-threatening organ dysfunction caused by a dysregulated host response to infection and “septic shock” the subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality (18).
Although application of Sepsis-3 to children has been attempted (19, 20), formal revisions to the 2005 pediatric sepsis definitions remain pending (21).
Therefore, the majority of studies used to establish evidence for these guidelines referred to the 2005 nomenclature in which severe sepsis was defined as 1) greater than or equal to 2 age-based systemic inflammatory response syndrome (SIRS) criteria, 2) confirmed or suspected invasive infection, and 3) cardiovascular dysfunction, acute respiratory distress syndrome (ARDS), or greater than or equal to 2 noncardiovascular organ system dysfunctions; and septic
shock was defined as the subset with cardiovascular dysfunction, which included hypotension, treatment with a vasoactive medication, or impaired perfusion.For the purposes of these guidelines, we define septic shock
in children as severe infection leading to cardiovascular dysfunction (including hypotension, need for treatment with a
vasoactive medication, or impaired perfusion) and “sepsis associated organ dysfunction” in children as severe infection
leading to cardiovascular and/or noncardiovascular organ dysfunction. Because several methods to identify acute organ dysfunction in children are currently available (17, 19, 20, 22, 23), we chose not to require a specific definition or scheme for this purpose.Beginning of the article
Sepsis is a leading cause of morbidity, mortality, and healthcare utilization for children worldwide. Globally, an estimated 22 cases of childhood sepsis per 100,000 person-years and 2,202 cases of neonatal sepsis per 100,000 live births occur, translating into 1.2 million cases of childhood sepsis per year (1). More than 4% of all hospitalized patients less than 18 years and ~8% of patients admitted to PICUs in high-income countries have sepsis (2–6). Mortality for children with sepsis ranges from 4% to as high as 50%, depending on illness severity, risk factors, and geographic location (2, 3, 7–9). The majority of children who die of sepsis suffer from refractory shock and/or multiple organ dysfunction syndrome, with many deaths occurring within the initial 48 to 72 hours of treatment (10–13). Early identification and appropriate resuscitation and management are therefore critical to optimizing outcomes for children with sepsis.
