Table 3 . Goals of Therapy for Pediatric Severe Sepsis and Shock Therapeutic Goals in Pediatric Severe Sepsis and Shock
• Support oxygenation and ventilation . Goal SpO 2
*
> 94 %
• Restore circulatory perfusion . 60 mL / kg in the first hour with frequent reassessment
• Administer broad spectrum antibiotics in the first hour Target SpO 2
*
> 94 % Capillary refill < 2 seconds Normal blood pressure for age Normal pulses ( centrally and peripherally ) Warm extremities
*
SpO 2 - peripheral arterial oxygen saturation
widely available and easy to administer . Consider the child ’ s age and history when determining antibiotic choices , as certain situations may necessitate the use of an alternative ( e . g ., infants under one month of age , history of previously positive cultures , and immunosuppression ). The overall treatment goals are to 1 ) restore peripheral and end-organ perfusion , 2 ) achieve a normal heart rate for age , 3 ) attain a normal blood pressure for age , and 4 ) establish adequate oxygenation , ventilation , and circulation within the first hour of shock recognition . 8 The child should be reassessed after each intervention while targeting specific therapeutic goals ( Table 3 ). 9
Disposition
All children with proven or suspected severe sepsis or septic shock should be hospitalized . If hemodynamically stable , a child may be admitted to the inpatient floor , but all children with septic shock should be admitted to a PICU .
Conclusion
Children are not just small adults , and due to their different pathophysiology , pediatric sepsis remains difficult to diagnose with potentially serious consequences . It is important to remember that sepsis is a clinical diagnosis . Pediatric sepsis may present with only persistent tachycardia ; hypotension will not occur until they are in uncompensated shock . Septic children can look well and still be septic ; they often show subtle signs of stress as compared with adults . It is essential to keep pediatric sepsis on a physician ’ s differential and , when recognized , to act quickly . Obtaining IV access , giving a fluid bolus , administering broad-spectrum antibiotics and starting a patient on supplemental oxygen while transferring to a higher level of care are prompt and effective actions to take to improve the care of children in almost any location .
Normal mental status Urine output of 1 mL / kg / hour Normal serum glucose Normal serum calcium
References
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