Septic shock in children

Key Aspects ◽

Chapter 1 begins by examining the definitions of sepsis and septic shock as subsets of the systemic inflammatory response syndrome, discusses the epidemiology of paediatric sepsis, and provides a structured approach to the assessment of a child with suspected sepsis. The evidence for and limitation of investigations, such as lactate measurement and attempted quantification of cardiac function in paediatric sepsis, is examined. Optimal management strategies for paediatric sepsis remain much studied and debated. This chapter addresses the use of inotropes—both early inotropes and choice of inotropes, intravenous fluids, including the current evidence base for choice of fluids, and the increasingly studied areas of fluid overload and fluid removal (de-resuscitation) following the initial phases of resuscitation. The evidence base for use and timing of antibiotics and steroids is discussed, along with the roles of the supportive therapies renal replacement therapy and extracorporeal membrane oxygenation. Finally, the chapter examines some of the key aspects of the care of patients with sepsis of relevance to intensivists: early goal-directed therapy; sepsis bundles; and the Surviving Sepsis Campaign.

Faculty Opinions recommendation of Prospective external validation of the clinical effectiveness of an emergency department-based early goal-directed therapy protocol for severe sepsis and septic shock.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1092208.545603 ◽

2007 ◽

Author(s):

Patrick Ray

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Severe Sepsis ◽

External Validation ◽

Clinical Effectiveness ◽

Goal Directed Therapy ◽

Sepsis And Septic Shock ◽

Therapy Protocol

Treatment of suspected sepsis and septic shock in children with chronic disease seen in the pediatric emergency department

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2021.01.026 ◽

2021 ◽

Vol 44 ◽

pp. 56-61

Author(s):

Emily Hegamyer ◽

Nadine Smith ◽

Amy D. Thompson ◽

Andrew D. Depiero

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Chronic Disease ◽

Pediatric Emergency ◽

Pediatric Emergency Department ◽

Suspected Sepsis ◽

Early Goal-Directed Therapy in Severe Sepsis and Septic Shock Revisited

CHEST Journal ◽

10.1378/chest.130.5.1579 ◽

2006 ◽

Vol 130 (5) ◽

pp. 1579-1595 ◽

Cited By ~ 195

Author(s):

Ronny M. Otero ◽

H. Bryant Nguyen ◽

David T. Huang ◽

David F. Gaieski ◽

Munish Goyal ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Goal Directed Therapy ◽

Toward the diagnosis of rare childhood genetic diseases: what do parents value most?

European Journal of Human Genetics ◽

10.1038/s41431-021-00882-1 ◽

2021 ◽

Author(s):

Samantha Pollard ◽

Deirdre Weymann ◽

Jessica Dunne ◽

Fatemeh Mayanloo ◽

John Buckell ◽

...

Keyword(s):

Focus Groups ◽

Genetic Disease ◽

Diagnostic Yield ◽

Management Strategies ◽

Health Benefit ◽

Sampling Technique ◽

Evidence Base ◽

Current Evidence ◽

Genomic Testing ◽

Current Evidence Base

AbstractGenomic testing is becoming routine for diagnosing rare childhood genetic disease. Evidence underlying sustainable implementation is limited, focusing on short-term endpoints such as diagnostic yield, unable to fully characterize patient and family valued outcomes. Although genomic testing is becoming widely available, evidentiary and outcomes uncertainty persist as key challenges for implementation. We examine whether the current evidence base reflects public tolerance for uncertainty for genomics to diagnose rare childhood genetic disease. We conducted focus groups with general population parents in Vancouver, Canada, and Oxford, United Kingdom, to discuss expectations and concerns related to genomic testing to diagnose rare childhood genetic disease. Applying a purposive sampling technique, recruitment continued until thematic saturation was reached. Transcripts were analysed using thematic analysis. Thirty-three parents participated across four focus groups. Participants valued causal diagnoses alongside management strategies to improve patient health and wellbeing. Further, participants valued expanding the evidence base to reduce evidentiary uncertainty while ensuring security of information. Willingness to pay out of pocket for testing reflected perceived familial health benefit. Diagnostic yield fails to fully capture valued outcomes, and efforts to resolve uncertainty better reflect public priorities. Evaluations of genomic testing that fully integrate valued endpoints are necessary to ensure consistency with best practices and public willingness to accept the uncertain familial benefit.

Early goal-directed therapy prevents organ failure and mortality in severe sepsis and septic shock

Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E. ◽

10.1007/978-88-470-2215-7_38 ◽

2003 ◽

pp. 1089-1103

Author(s):

E. Rivers ◽

B. Nguyen ◽

S. Havstad

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Organ Failure ◽

Goal Directed Therapy ◽

Projected Impact of Early Goal Directed Therapy on Hospital Resource Utilization for Severe Sepsis and Septic Shock Patients

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2005.06.093 ◽

2005 ◽

Vol 46 (3) ◽

pp. 24 ◽

Cited By ~ 2

Author(s):

K. Barlotta ◽

K. Scully ◽

R.S. Sawer ◽

J. Ebarb ◽

T.M. Osborn

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Resource Utilization ◽

Hospital Resource ◽

Goal Directed Therapy ◽

Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0020 ◽

2018 ◽

pp. 104-108

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Septic Shock ◽

Severe Sepsis ◽

Intensive Care ◽

Oxygen Demand ◽

Goal Directed Therapy ◽

Study Results ◽

This case focuses on detecting sepsis through early goal-directed therapies by asking the question: Does aggressive correction of hemodynamic disturbances in the early stages of sepsis improve outcomes? Early goal-directed therapies are aimed at restoring a balance between oxygen delivery and oxygen demand. Patients included in the study were adults presenting to the emergency room with severe sepsis or septic shock. Study results indicated that most patients with severe sepsis or septic shock should be managed with aggressive hemodynamic monitoring and support immediately on presentation in the emergency department (or, if this is not possible, in the intensive care unit) for 6 hours or until there is resolution of hemodynamic disturbances.

Usefulness of the heparin-binding protein level to diagnose sepsis and septic shock according to Sepsis-3 compared with procalcitonin and C reactive protein: a prospective cohort study in China

BMJ Open ◽

10.1136/bmjopen-2018-026527 ◽

2019 ◽

Vol 9 (4) ◽

pp. e026527 ◽

Cited By ~ 6

Author(s):

Yixuan Zhou ◽

Zhen Liu ◽

Jun Huang ◽

Guiling Li ◽

Fengying Li ◽

...

Keyword(s):

Septic Shock ◽

Cohort Study ◽

Roc Curve ◽

Prospective Cohort ◽

Heparin Binding ◽

C Reactive Protein ◽

Suspected Sepsis ◽

Reactive Protein ◽

Heparin Binding Protein ◽

ObjectivesOur aim was to assess the release level of heparin-binding protein (HBP) in sepsis and septic shock under theThird International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3).DesignProspective cohort study.SettingA general teaching hospital in China.ParticipantsAdult infected patients with suspected sepsis and people who underwent physical examination were included. According to the health status and severity of illness, the research subjects were divided into healthy, local infection, sepsis non-shock and septic shock under Sepsis-3 definitions.Main outcome measuresPlasma levels of HBP, procalcitonin (PCT), C reactive protein (CRP) and complete blood count were detected in all subjects. Single-factor analysis of variance was used to compare the biomarker levels of multiple groups. A receiver operating characteristic (ROC) curve was used to assess the diagnostic capacity of each marker.ResultsHBP levels were significantly higher in patients with sepsis non-shock than in those with local infections (median 49.7ng/mL vs 11.8 ng/mL, p<0.01) at enrolment. Moreover, HBP levels in patients with septic shock were significantly higher than in patients with sepsis without shock (median 153.8ng/mL vs 49.7 ng/mL, p<0.01). The area under the ROC curve (AUC) of HBP (cut-off ≥28.1 ng/mL) was 0.893 for sepsis which was higher than those of PCT (0.856) for a cut-off ≥2.05 ng/mL and of CRP (0.699) for a cut-off ≥151.9 mg/L. Moreover, AUC of HBP (cut-off ≥103.5 ng/mL) was 0.760 for septic shock which was higher than the ROC curve of sequential [sepsis-related] organ failure assessment (SOFA) Score (0.656) for a cut-off ≥5.5. However, there was no significant difference between 28-d survivors (n=56) and 28-d non-survivors (n=37) with sepsis in terms of HBP value (p=0.182).ConclusionsA high level of HBP in plasma is associated with sepsis, which might be a useful diagnostic marker in patients with suspected sepsis.