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Published on: June 15, 2019
Diagnosis and management of severe sepsis in the paediatric patient
1Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario.
Insights
Recognizing sepsis early through vital sign changes is crucial for prompt treatment. Recent guidelines emphasize careful fluid administration and updated vasoactive medication choices for pediatric sepsis management.
Area of Science:
- Pediatric critical care medicine
- Infectious disease management
- Systemic inflammatory response syndrome
Background:
- Sepsis poses significant morbidity and mortality risks.
- Professional societies have developed guidelines for sepsis recognition and management.
- This practice point summarizes recent sepsis management guidelines.
Purpose of the Study:
- To outline key elements of current sepsis management guidelines.
- To highlight recent updates in pediatric sepsis care.
- To provide a concise overview for clinicians managing sepsis in youth.
Main Methods:
- Review and synthesis of recent professional society guidelines for sepsis management.
- Focus on recognition, initial stabilization, and therapeutic interventions.
- Emphasis on pediatric-specific considerations and guideline changes.
Main Results:
- Key elements include recognizing clinical changes, stabilizing ABCs, administering antimicrobials, and using fluids/vasopressors.
- Guidelines now stress vigilance for fluid overload and re-assessment after fluid boluses.
- Dopamine is no longer the initial vasoactive agent for hypotensive pediatric patients; epinephrine or norepinephrine are recommended.
Conclusions:
- Timely recognition and management are vital for improving sepsis outcomes in children.
- Updated guidelines provide critical adjustments for fluid management and vasoactive agent selection in pediatric sepsis.
- Adherence to current guidelines is essential for effective sepsis care in infants, children, and adolescents.
Abstract:
Sepsis is a systemic inflammatory response to suspected or proven infection. Given its importance in terms of morbidity and mortality, a number of initiatives by several professional societies in recent years have led to the development of guidelines for the recognition and timely management of sepsis. The principal elements of the most recent guidelines are summarized in this practice point. These elements include recognition of changes in clinical condition and vital signs, such as fever, tachycardia, and changes in peripheral perfusion, which should raise concern for sepsis; initial stabilization of airway, breathing, and circulation; timely administration of empiric antimicrobial therapy; use of fluid boluses and vasoactive medications; and specific considerations in patients with underlying medical conditions, such as the use of corticosteroids for possible adrenal insufficiency due to hypothalamic-adrenal suppression. Two changes from previous guidelines are the concern for fluid overload, implying the need for clinical re-assessment after administration of each fluid bolus, and the removal of dopamine as the initial vasoactive agent for use in hypotensive paediatric patients, with recommendations for the use of epinephrine or norepinephrine as dictated by the clinical context. This practice point focuses primarily on sepsis management in older infants, children, and youth.
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