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Updated: Jul 25, 2025

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Haemodynamic support for paediatric septic shock: a global perspective.

Suchitra Ranjit1, Niranjan Kissoon2, Andrew Argent3

  • 1Paediatric Intensive Care Unit, Apollo Children's Hospital, Chennai, India.

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Summary

Pediatric septic shock management requires reassessment, especially in low-resource settings. This viewpoint discusses fluid resuscitation, vasoactive agents, and monitoring for improved global pediatric sepsis care.

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Area of Science:

  • Pediatric Critical Care Medicine
  • Global Health
  • Infectious Diseases

Background:

  • Septic shock is a major global cause of child mortality.
  • The 2020 Pediatric Surviving Sepsis Campaign (SSC) guidelines provide evidence-based recommendations.
  • Recent trials from diverse settings, including LMICs, offer new insights into sepsis management.

Purpose of the Study:

  • To critically reassess the application of current SSC guidelines in low- and middle-income countries (LMICs).
  • To discuss key concepts in pediatric septic shock management relevant to global settings, particularly LMICs.
  • To highlight challenges and opportunities for improving pediatric sepsis care in resource-limited environments.

Main Methods:

  • This viewpoint critically analyzes recent clinical trial data and expert experience.
  • It focuses on three core areas: early recognition, initial hemodynamic support, and resuscitation endpoints.
  • It incorporates insights from both LMICs and high-income countries.

Main Results:

  • Uncertainties persist regarding early recognition and optimal initial hemodynamic support for pediatric septic shock.
  • Controversies exist around early fluid resuscitation and vasoactive agent use, influenced by evolving clinical phenotypes.
  • Simple, accessible monitoring tools are crucial for applying guidelines and individualizing care in LMICs.

Conclusions:

  • Adapting global pediatric sepsis guidelines to LMIC realities is essential.
  • Individualized hemodynamic support, guided by accessible monitoring, is key.
  • Further research and dialogue are needed to optimize treatment pathways in diverse settings.