Abstract
The implementation of managed protocols contributes to a systematized approach to the patient and continuous evaluation of results, focusing on improving clinical practice, early diagnosis, treatment, and outcomes. Advantages to the adoption of a pediatric sepsis recognition and treatment protocol include: a reduction in time to start fluid and antibiotic administration, decreased kidney dysfunction and organ dysfunction, reduction in length of stay, and even a decrease on mortality. Barriers are: absence of a written protocol, parental knowledge, early diagnosis by healthcare professionals, venous access, availability of antimicrobials and vasoactive drugs, conditions of work, engagement of healthcare professionals. There are challenges in low-middle-income countries (LMIC). The causes of sepsis and resources differ from high-income countries. Viral agent such as dengue, malaria are common in LMIC and initial approach differ from bacterial infections. Some authors found increased or no impact in mortality or increased length of stay associated with the implementation of the SCC sepsis bundle which reinforces the importance of adapting it to most frequent diseases, disposable resources, and characteristics of healthcare professionals. Conclusions: (1) be simple; (2) be precise; (3) education; (5) improve communication; (5) work as a team; (6) share and celebrate results.
Highlights
Sepsis is a major childhood disease in terms of frequency and severity [1]
Surveys applied in France and Saudi Arabia to pediatric intensivists showed that an absence of a written protocol was one of greatest barrier to adoption of systematic treatment according to Sepsis Campaign (SSC) guidelines [10, 11]
We summarized the barriers to protocol implementation and possible solutions on Table 1
Summary
Sepsis is a major childhood disease in terms of frequency and severity [1]. The incidence of sepsis is increasing in the pediatric population, mainly due to the higher survival of very low-birth-weight infants and children with chronic conditions [1]. The implementation of managed protocols contributes to a systematized approach and to a continuous evaluation of results, always focusing on improving clinical practice and outcomes [2,3,4]. Protocols might help clinicians treat sepsis because they make a systematic approach, early diagnosis, and treatment easier and through. How to implement a pediatric sepsis protocol successfully? This is a narrative review that includes the history of sepsis protocols, the importance of its utilization, barriers to implementation, and proposed solutions
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