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Care Pathway and Outcomes in Pediatric Septic Shock: A Narrative Review from Emergency Department Recognition to PICU
Efrossini Briassouli1, George Briassoulis2
1Second Department of Paediatrics, Aglaia Kyriakou Children's Hospital, School of Medicine, National and Kapodistrian University of Athens, 10679 Athens, Greece.
Insights
Pediatric septic shock management requires a continuum-of-care approach, not just intensive care. Early recognition and treatment across all hospital settings improve outcomes for children with septic shock.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Emergency medicine
Background:
- Pediatric septic shock is a significant cause of child mortality and morbidity.
- Effective management necessitates timely recognition and intervention across various hospital settings.
- Outcomes are influenced by care received before and during pediatric intensive care unit (PICU) admission.
Purpose of the Study:
- To review the entire hospital care trajectory for pediatric septic shock.
- To emphasize diagnostic challenges, early treatment, care escalation, and prognostic assessment.
- To explore management from emergency department recognition to PICU outcomes.
Main Methods:
- A narrative review utilizing a structured literature search.
- Inclusion of international guidelines, consensus statements, systematic reviews, and pediatric studies.
- Focus on recognition, resuscitation, escalation, PICU management, and outcomes in pediatric septic shock.
Main Results:
- Pediatric septic shock is a dynamic continuum, complicated by age-dependent physiology and nonspecific symptoms.
- Key interventions include timely antimicrobials, individualized fluid resuscitation, early vasoactive support, and reassessment.
- Prompt escalation to PICU and phenotype-informed management in the PICU are crucial for improving outcomes beyond mortality.
Conclusions:
- Outcomes in pediatric septic shock are determined by the complete hospital care pathway.
- A continuum-of-care, trajectory-based approach can enhance diagnosis, escalation, and both short- and long-term patient results.
Background:
Pediatric septic shock remains a major cause of morbidity and mortality and requires timely recognition and management across multiple hospital settings. Although intensive care support is critical, outcomes are also influenced by earlier phases of care, including emergency department recognition, first-hour treatment, inpatient monitoring, and timely escalation to the pediatric intensive care unit (PICU).
Objective:
We aimed to review pediatric septic shock across the full hospital trajectory, from emergency department recognition to PICU management and outcomes, with emphasis on diagnostic challenges, early treatment, escalation of care, and prognostic assessment.
Methods:
This narrative review was based on a structured literature search of PubMed/MEDLINE, Scopus, and the Cochrane Library, with emphasis on international guidelines, consensus statements, systematic reviews, and clinically relevant pediatric studies addressing recognition, resuscitation, escalation, intensive care management, and outcomes in pediatric septic shock.
Results:
Pediatric septic shock is best approached as a dynamic continuum rather than a single event. Early recognition is complicated by age-dependent physiology, nonspecific presentation, and delayed hypotension. Timely antimicrobial therapy, individualized fluid resuscitation, early vasoactive support, and repeated reassessment during the first hours are central to management. Ward surveillance and prompt escalation to PICU are critical, as delayed recognition of deterioration may worsen organ dysfunction and resource use. In the PICU, phenotype-informed hemodynamic support, fluid stewardship, respiratory support, and organ support are essential. Outcomes should be evaluated beyond mortality to include organ dysfunction burden, duration of support, length of stay, and longer-term functional recovery.
Conclusions:
Pediatric septic shock outcomes are shaped by the entire hospital care pathway rather than PICU treatment alone. A trajectory-based, continuum-of-care approach may improve timely diagnosis, escalation, and short- and longer-term outcomes.
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