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Medication and Fluid Management of Pediatric Sepsis and Septic Shock

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Abstract

Sepsis is a life-threatening response to infection that contributes significantly to neonatal and pediatric morbidity and mortality worldwide. The key tenets of care include early recognition of potential sepsis, rapid intervention with appropriate fluids to restore adequate tissue perfusion, and empiric antibiotics to cover likely pathogens. Vasoactive/inotropic agents are recommended if tissue perfusion and hemodynamics are inadequate following initial fluid resuscitation. Several adjunctive therapies have been suggested with theoretical benefit, though definitive recommendations are not yet supported by research reports. This review focuses on the recommendations for medication and fluid management of pediatric sepsis and septic shock, highlighting issues related to antibiotic choices and antimicrobial stewardship, selection of intravenous fluids for resuscitation, and selection and use of vasoactive/inotropic medications. Controversy remains regarding resuscitation fluid volume and type, antibiotic choices depending upon infectious risks in the patient’s community, and adjunctive therapies such as vitamin C, corticosteroids, intravenous immunoglobulin, and methylene blue. We include best practice recommendations based on international guidelines, a review of primary literature, and a discussion of ongoing clinical trials and the nuances of therapeutic choices.

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Authors and Affiliations

  1. Division of Pediatric Critical Care, Department of Pediatrics, Primary Children’s Hospital, University of Utah, 100 North Mario Capecchi Drive, Salt Lake City, UT, 84113, USA

    Lauren Burgunder, Jennifer K. Workman & Gitte Y. Larsen

  2. Division of Primary Children’s Hospital Pharmacy, Salt Lake City, UT, USA

    Caroline Heyrend, Jared Olson & Chanelle Stidham

  3. Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

    Jared Olson

  4. Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

    Roni D. Lane

Authors
  1. Lauren Burgunder
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  2. Caroline Heyrend
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  3. Jared Olson
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  4. Chanelle Stidham
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  5. Roni D. Lane
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  6. Jennifer K. Workman
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  7. Gitte Y. Larsen
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Corresponding author

Correspondence to Gitte Y. Larsen.

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Funding

No sources of financial assistance were used to conduct the study described in the article and/or to assist with the preparation of the article. Dr. Workman’s institution is receiving ongoing career development salary and research support from the Intermountain Foundation through the University of Utah CTSI Partner Career Development Program and from the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR002538). The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health or the Intermountain Foundation.

Conflicts of interest

Lauren Burgunder, Caroline Heyrend, Jared Olson, Chanelle Stidham, Roni D. Lane, Jennifer K. Workman, and Gitte Y. Larsen have no conflicts of interest that are directly relevant to the content of this article.

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Author contributions

Drs. Burgunder and Larsen conceptualized and designed the study, drafted the initial manuscript, and revised the manuscript. Pharmacists Heyrend, Olson, and Stidham drafted sections of the initial manuscript. All authors reviewed and recommended revisions to the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Burgunder, L., Heyrend, C., Olson, J. et al. Medication and Fluid Management of Pediatric Sepsis and Septic Shock. Pediatr Drugs 24, 193–205 (2022). https://doi.org/10.1007/s40272-022-00497-z

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  • DOI: https://doi.org/10.1007/s40272-022-00497-z

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