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Sepsis

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Update in Pediatrics

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Abstract

Sepsis and sepsis-associated organ dysfunction remains a leading cause of morbidity and mortality in the pediatric population. The diagnosis of septic shock should be made in children with sepsis (SIRS with infection) and signs of cardiovascular compromise and inadequate tissue perfusion (decreased or altered mental status, decreased urine output, abnormalities in skin perfusion and pulses). PALS-ACCM guidelines and the Pediatric Surviving Sepsis guidelines outline the key steps in the recognition and management of septic shock. Early volume resuscitation and broad spectrum antibiotics remain the cornerstones of therapy. Vasoactive agents (epinephrine or norepinephrine) are indicated when a patient remains in shock despite 40–60 mL/kg of fluid resuscitation (‘fluid-refractory shock’). Standardized emergency department sepsis screening tools and protocols, which rely on abnormal vital signs and physical examination findings to help identify patients at risk, have been shown to reduce time to both fluids and antibiotic administration.

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References

  • Abulebda K, Cvijanovich NZ, Thomas NJ, et al. Post-ICU admission fluid balance and pediatric septic shock outcomes: a risk-stratified analysis. Crit Care Med. 2014;42(2):397–403.

    Article  PubMed  PubMed Central  Google Scholar 

  • Alobaidi R, Morgan C, Basu RK, et al. Association between fluid balance and outcomes in critically ill children: a systematic review and meta-analysis. JAMA Pediatr. 2018;172(3):257–68.

    Article  PubMed  PubMed Central  Google Scholar 

  • Arikan A, et al. Resuscitation bundle in pediatric shock decreases acute kidney injury and improves outcomes. J Pediatr. 2015;167:1301–5.

    Article  Google Scholar 

  • Balamuth F, Weiss SL, Neuman MI, et al. Pediatric severe sepsis in U.S. children’s hospitals. Pediatr Crit Care Med. 2014;15:798.

    Article  PubMed  PubMed Central  Google Scholar 

  • Balamuth F, et al. Improving recognition of pediatric severe sepsis in the emergency department: contributions of a vital sign-based electronic alert and bedside clinician identification. Ann Emerg Med. 2017;70(6):759–68.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brierley J, Carcillo JA, Choong K, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009;37:666.

    Article  PubMed  PubMed Central  Google Scholar 

  • Carcillo JA, Kuch BA, Han YY, et al. Mortality and functional morbidity after use of PALS/APLS by community physicians. Pediatrics. 2009;124(2):500.

    Article  PubMed  Google Scholar 

  • Cruz AT, Perry AM, Williams EA, et al. Implementation of goal-directed therapy for children with suspected sepsis in the emergency department. Pediatrics. 2011;127:e758.

    Article  PubMed  Google Scholar 

  • Davis A, et al. The American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med. 2017;45(16):1061–93.

    Article  PubMed  Google Scholar 

  • De Caen A, Berg MD, Chameides L, et al. Part 12: Pediatric Advanced Life Support. 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S526–42.

    PubMed  PubMed Central  Google Scholar 

  • Eisenberg M, Balmuth F. Pediatric sepsis screening in US hospitals. Pediatr Res. 2022;91(2):351–8.

    Article  PubMed  Google Scholar 

  • Emrath ET, Fortenberry JD, Travers C, et al. Resuscitation with balanced fluids is associated with improved survival in pediatric severe sepsis. Crit Care Med. 2017;45:1177–83.

    Article  PubMed  Google Scholar 

  • Evans I, et al. Association between the New York sepsis care mandate and in-hospital mortality for pediatric sepsis. JAMA. 2018;320(4):358–67.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fleischmann-Struzek C, et al. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med. 2018;6:223–30.

    Article  PubMed  Google Scholar 

  • Gaines NN, Patel B, Williams EA, Cruz AT. Etiologies of septic shock in a pediatric emergency department population. Pediatr Infect Dis J. 2012;31:1203.

    Article  PubMed  Google Scholar 

  • Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6:2.

    Article  PubMed  Google Scholar 

  • Hartman ME, Linde-Zwirble WT, Angus DC, Watson RS. Trends in the epidemiology of pediatric severe sepsis. Pediatr Crit Care Med. 2013;14:686.

    Article  PubMed  Google Scholar 

  • Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med. 2003;348:138.

    Article  CAS  PubMed  Google Scholar 

  • Kleinman ME, de Caen AR, Chameides L, et al. Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Pediatrics. 2010;126:e1261.

    Article  PubMed  Google Scholar 

  • Kutko MC, Calarco MP, Flaherty MB, et al. Mortality rates in pediatric septic shock with and without multiple organ system failure. Pediatr Crit Care Med. 2003;4:333.

    Article  PubMed  Google Scholar 

  • Lane R, et al. High reliability pediatric septic shock quality improvement initiative and decreasing mortality. Pediatrics. 2016;138(4):e20154153.

    Article  PubMed  Google Scholar 

  • Larsen GY, Mecham N, Greenberg R. An emergency department septic shock protocol and care guideline for children initiated at triage. Pediatrics. 2011;127:e1585–92.

    Article  PubMed  Google Scholar 

  • Maconochie I, et al. Pediatric life support: 2020 International consensus on cardiopulmonary resuscitation emergency cardiovascular care science with treatment recommendations. Circulation. 2020;142:S140–84.

    Article  PubMed  Google Scholar 

  • Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection. N Engl J Med. 2011;364:2483.

    Article  CAS  PubMed  Google Scholar 

  • Menon K, et al. Criteria for pediatric sepsis—A systematic review and meta analysis by the pediatric sepsis definition taskforce. Crit Care Med. 2022;50:21–36.

    Article  PubMed  Google Scholar 

  • Oliveira CF, Nogueira de Sá FR, Oliveira DS, et al. Time- and fluid-sensitive resuscitation for hemodynamic support of children in septic shock: barriers to the implementation of the American College of Critical Care Medicine/Pediatric Advanced Life Support Guidelines in a pediatric intensive care unit in a developing world. Pediatr Emerg Care. 2008;24(12):810.

    Article  PubMed  Google Scholar 

  • Paul R, Neuman MI, Monuteaux MC, Melendez E. Adherence to PALS sepsis guides decreases hospital length of stay. Pediatrics. 2012;130:e273–80.

    Article  PubMed  Google Scholar 

  • Paul R, Melendez E, Stack A, et al. Improving adherence to PALS septic shock guidelines. Pediatrics. 2014;133(5):e1358–66.

    Article  PubMed  Google Scholar 

  • Peshimam N, et al. Peripheral and central/intraosseous vasoactive infusions during and after pediatric critical care transport: retrospective cohort study of extravasation injury. Pediatr Crit Care Med. 2022;23(8):626.

    Article  PubMed  Google Scholar 

  • Prout AJ, et al. Children with chronic disease bear the highest burden of pediatric sepsis. J Pediatr. 2018;199:194–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ruth A, McCracken CE, Fortenberry JD, et al. Pediatric severe sepsis: current trends and outcomes from the Pediatric Health Information Systems database. Pediatr Crit Care Med. 2014;15:828.

    Article  PubMed  Google Scholar 

  • Schlapbach LJ, MacLaren G, Festa M; et al. Australian & New Zealand Intensive Care Society (ANZICS) Centre for Outcomes & Resource Evaluation (CORE) and Australian & New Zealand Intensive Care Society (ANZICS) Paediatric Study Group. Prediction of pediatric sepsis mortality within 1 h of intensive care admission. Intensive Care Med. 2017;43:1085–96.

    Google Scholar 

  • Scott HF, Donoghue AJ, Gaieski DF, et al. The utility of early lactate testing in undifferentiated pediatric systemic inflammatory response syndrome. Acad Emerg Med. 2012;19:1276.

    Article  PubMed  Google Scholar 

  • Scott HF, Brou L, Deakyne SJ, et al. Lactate clearance and normalization and prolonged organ dysfunction in pediatric sepsis. J Pediatr. 2016;170:149–55.

    Article  CAS  PubMed  Google Scholar 

  • Scott HF, et al. Association between early lactate levels and 30-day mortality in clinically suspected sepsis in children. JAMA Pediatr. 2017;171(3):249–55.

    Article  PubMed  Google Scholar 

  • Semler MW, Self WH, Wanderer JP, et al. SMART Investigators and the pragmatic critical care research group: balanced crystalloids versus saline in critically ill adults. N Engl J Med. 2018;378:829–39.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shankar-Hari M, et al. Sepsis definitions task force: developing a new definition and assessing new clinical criteria for septic shock: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:775–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ventura AM, Shieh HH, Bousso A, et al. Double-blind prospective randomized controlled trial of dopamine versus epinephrine as first-line vasoactive drugs in pediatric septic shock. Crit Care Med. 2015;43:2292.

    Article  CAS  PubMed  Google Scholar 

  • Watson RS, Carcillo JA, Linde-Zwirble WT, et al. The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med. 2003;167:695.

    Article  PubMed  Google Scholar 

  • Weiss SL, Parker B, Bullock ME, et al. Defining pediatric sepsis by different criteria: discrepancies in populations and implications for clinical practice. Pediatr Crit Care Med. 2012;13:e219.

    Article  PubMed  Google Scholar 

  • Weiss SL, et al. Delayed antimicrobial therapy increases mortality and organ dysfunction duration in pediatric sepsis. Crit Care Med. 2014;42:2409–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Weiss SL, Fitzgerald JC, Pappachan J, et al. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study. Am J Respir Crit Care Med. 2015a;191:1147.

    Article  PubMed  PubMed Central  Google Scholar 

  • Weiss SL, Fitzgerald JC, Maffei FA et al. SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network. Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study. Crit Care. 2015b;19:325.

    Google Scholar 

  • Weiss SL, Keele L, Balamuth F, et al. Crystalloid fluid choice and clinical outcomes in pediatric sepsis: a matched retrospective cohort study. J Pediatr. 2017;182:304–310.e10.

    Article  PubMed  PubMed Central  Google Scholar 

  • Weiss SL, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med. 2020;21:e52–e106.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Toronto, Toronto, ON, Canada

    Deborah Schonfeld

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  1. Deborah Schonfeld
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Correspondence to Deborah Schonfeld .

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Editors and Affiliations

  1. Pediatrician, Kidcrew Pediatric Medical Clinic, Toronto, ON, Canada

    Shalea Beckwith

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Schonfeld, D. (2023). Sepsis. In: Beckwith, S. (eds) Update in Pediatrics. Springer, Cham. https://doi.org/10.1007/978-3-031-41542-5_11

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  • DOI: https://doi.org/10.1007/978-3-031-41542-5_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-41541-8

  • Online ISBN: 978-3-031-41542-5

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