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Translational gap in pediatric septic shock management: an ESPNIC perspective
Luc Morin1, Martin Kneyber2,3, Nicolaas J G Jansen4
1Pediatric Intensive Care Unit, Bicêtre University Hospital, AP-HP, South Paris University, Le Kremlin-Bicêtre, France.
Insights
Pediatric septic shock management varies among clinicians, deviating from guidelines. This survey highlights limitations in current pediatric sepsis guidelines, emphasizing the need for context-specific approaches.
Area of Science:
- Pediatric Critical Care Medicine
- Septic Shock Management
- Clinical Practice Guidelines
Background:
- Established guidelines for pediatric septic shock management exist from the Surviving Sepsis Campaign and the American College of Critical Care Medicine.
- Variations in adherence to these recommendations among European pediatric intensive care physicians were assessed.
Purpose of the Study:
- To evaluate current clinical practices in pediatric septic shock management among European Society of Pediatric and Neonatal Intensive Care (ESPNIC) members.
- To identify deviations from existing evidence-based guidelines.
Main Methods:
- An electronic survey was distributed to 114 pediatric intensive care physicians.
- The survey included four standardized clinical cases covering seven distinct clinical scenarios.
Main Results:
- Fluid choices favored non-synthetic colloids (albumin) and crystalloids (isotonic saline), with volume expansion exceeding 60 ml/kg.
- Norepinephrine was the preferred first-line vasopressor (94%), contrary to guideline recommendations favoring dopamine or epinephrine.
- Early intubation was employed by 70%, and extracorporeal life support was considered by 91% in specific situations.
Conclusions:
- Significant variability exists in reported clinical practices for pediatric septic shock management.
- Current guidelines may have limitations in addressing the specific context and patient needs in pediatric septic shock.
- Findings underscore the need for guideline refinement to better align with clinical realities.
Background:
The Surviving Sepsis Campaign and the American College of Critical Care Medicine guidelines have provided recommendations for the management of pediatric septic shock patients. We conducted a survey among the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) members to assess variations to these recommendations.
Methods:
A total of 114 pediatric intensive care physicians completed an electronic survey. The survey consisted of four standardized clinical cases exploring seven clinical scenarios.
Results:
Among the seven different clinical scenarios, the types of fluids were preferentially non-synthetic colloids (albumin) and crystalloids (isotonic saline) and volume expansion was not limited to 60 ml/kg. Early intubation for mechanical ventilation was used by 70% of the participants. Norepinephrine was stated to be used in 94% of the PICU physicians surveyed, although dopamine or epinephrine is recommended as first-line vasopressors in pediatric septic shock. When norepinephrine was used, the addition of another inotrope was frequent. Specific drugs such as vasopressin or enoximone were used in < 20%. Extracorporeal life support was used or considered by 91% of the physicians audited in certain specific situations, whereas the use of high-flow hemofiltration was considered for 44%.
Conclusions:
This pediatric septic shock management survey outlined variability in the current clinician-reported practice of pediatric septic shock management. As most recommendations are not supported by evidence, these findings outline some limitation of existing pediatric guidelines in regard to context and patient's specificity.
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