Med Journal Jan 2021 Final - Page 16

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
1 . Weiss SL , Fitzgerald JC , Pappachan J , Wheeler D , Jaramillo-Bustamante JC , Salloo A , Singhi SC , Erickson S , Roy JA , Bush JL , Nadkarni VM , Thomas NJ ; Sepsis Prevalence , Outcomes , and Therapies ( SPROUT ) Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators ( PALISI ) Network . Global epidemiology of pediatric severe sepsis : the sepsis prevalence , outcomes , and therapies study . Am J Respir Crit Care Med . 2015 May 15 ; 191 ( 10 ): 1147-57 .
2 . Hartman ME , Linde-Zwirble WT , Angus DC , Watson RS . Trends in the epidemiology of pediatric severe sepsis . Pediatr Crit Care Med . 2013 Sep ; 14 ( 7 ): 686-93 .
3 . Schlapbach LJ , Straney L , Alexander J , MacLaren G , Festa M , Schibler A , Slater A , for the ANZICS Paediatric Study Group . Mortality related to invasive infections , sepsis , and septic shock in critically ill children in Australia and New Zealand , 2002-13 : a multicentre retrospective cohort study . Lancet Infect Dis . 2015 Jan ; 15 ( 1 ): 46-54 .
4 . Goldstein , B ; Giroir , B ; Randolph , A and Members of the International Consensus Conference on Pediatric Sepsis . International pediatric sepsis consensus conference : Definitions for sepsis and organ dysfunction in pediatrics . Pediatr Crit Care Med . 2005 Jan ; 6 ( 1 ): 2-8 .
5 . Biban P , Gaffuri M , Spaggiari S , Zaglia F , Serra A , Santuz P . Early recognition and management of shock in children . Pediatr Rep . 2012 ; 4 : e3 . doi : 10.4081 / pr . 2012 . e13 . Epub 2012 Mar 26 .
6 . Tavare A , O ’ Flynn N . Recognition , diagnosis , and early management of sepsis : NICE guideline . Br J Gen Pract . 2017 Apr ; 67 ( 657 ): 185-186 .
7 . Han YY , Carcillo JA , Dragotta MA , Bills DM , Watson RS , Westerman ME , Orr RA . Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome . Pediatrics , 2003 Oct ; 112 ( 4 ): 793-9 .
8 . Davis AL , Carcillo JA , Aneja RK , Deymann AJ , Lin JC , Nguyen TC , Okhuysen-Cawley RS , Relvas MS , Rozenfeld RA , Skippen PW ; Stojadinovic BJ , Williams EA , Yeh TS , Balamuth F , Brierley J , de Caen AR , Cheifetz IM , Choong K , Conway E Jr , Cornell T , Doctor A , Dugas MA , Feldman JD , Fitzgerald JC , Flori HR , Fortenberry JD , Graciano Al , Greenwald BM , Hall MW , Han YY , Hernan LJ , Irazuzta JE , Iselin E , van der Jagt EW , Jeffries HE , Kache S , Katyal C , Kissoon N , Kon AA , Kutko MC , MacLaren G , Maul T , Mehta R , Odetola F , Parbuoni K , Paul R , Peters MJ , Ranjit S , Reuter-Rice KE , Schnitzler EJ , Scott HF , Torres , A Jr , Weingarten-Abrams J , Weiss SL , Zimmerman JJ , Zuckerberg AL . American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock . Crit Care Med . 2017 June ; 45 ( 6 ): 1061-1093 .
9 . Rhodes A , Evans LE , Alhazzani W , Levy MM , Antonelli M , Ferrer R , Kumar A , Sevransky JE , Sprung CL , Nunnally ME , Rochwerg B , Rubenfeld GD , Angus DC , Annane D , Beale RJ , Bellinghan GJ , Bernard GR , Chiche JD , Coopersmith C , De Backer DP , French CJ , Fujishima S , Gerlach H , Hidalgo JL , Hollenberg SM , Jones AE , Karnad DR , Kleinpell RM , Koh Y , Lisboa TC , Machado FR , Marini JJ , Marshall JC , Mazuski JE , McIntyre LA , McLean AS , Mehta S , Moreno RP , Myburgh J , Navalesi P , Nishida O , Osborn TM , Perner A , Plunkett CM , Ranieri M , Schorr CA , Seckel MA , Seymour CW , Shieh L , Shukri KA , Simpson SQ , Singer M , Thompson BT , Townsend SR , Van der Poll T , Vincent JL , Wiersinga WJ , Zimmerman JL , Dellinger RP . Surviving Sepsis Campaign : International Guidelines for Management of Sepsis and Septic Shock : 2016 . Intensive Care Med . 2017 March ; 43 ( 3 ): 304-377 .
10 . Weiss SL , Fitzgerald JC , Balamuth F , Alpern ER , Lavelle J , Chilutti M , Grundmeier R , Nadkarni VM , Thomas NJ . Delayed antimicrobial therapy increases mortality and organ dysfunction duration in pediatric sepsis . Crit Care Med . 2014 Nov ; 42 ( 11 ): 2409-17 .
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