Abstract
BackgroundPediatric sepsis is an important cause of mortality and morbidity in low- and middle-income countries (LMIC), where there is a huge burden of infectious diseases. Despite shortage of resources, adapting protocol-based care has reduced sepsis-related deaths but survivors of pediatric sepsis are at risk of poor functional outcomes.ObjectivesTo perform a scoping review of the literature on functional outcomes of pediatric sepsis survivors after discharge from the intensive care unit (ICU) and discuss the implications for patients in LMICs. The outcomes include prevalence of survival with reduced functional outcomes or quality of life (QoL) and changes over time during follow-up or recovery, and these outcomes were compared with other groups of children.MethodsWe searched major medical electronic databases for relevant literature from January 2005 until November 2021, including Medline (via PubMed), Embase, CINAHL, and Google Scholar databases. We included observational studies and follow-up data from clinical trials involving children/adolescents (≤18 years) who were admitted to pediatric intensive care unit (PICU) and got discharged finally. Major focus was on survivors of sepsis in LMIC. We followed PRISMA guidelines for scoping reviews (PRISM-ScR).ResultsWe included eight papers reporting data of functional outcomes in 2,915 children (males = 53%, and comorbidity present in 56.6%). All included studies were either a prospective or retrospective cohort study. Studies were classified as Level II evidence. Disabilities affecting physical, cognitive, psychological, and social function were reported in children following discharge. Overall disability reported ranged between 23 and 50% at hospital discharge or 28 days. Residual disability was reported at 1, 3, 6, and 12 months of follow-up with an overall improving trend. Failure to recover from a baseline HRQL on follow-up was seen in one-third of survivors. Organ dysfunction scores such as pSOFA, PeLOD, vasoactive inotrope score, neurological events, immunocompromised status, need for CPR, and ECMO were associated with poor functional outcome.ConclusionsThe research on functional outcomes in pediatric sepsis survivors is scarce in LMIC. Measuring baseline and follow-up functional status, low-cost interventions to improve management of sepsis, and multidisciplinary teams to identify and treat disabilities may improve functional outcomes.
Highlights
Sepsis is a state of dysregulated host response to infection and a major cause of mortality and morbidity
Studies were classified as Level II evidence
Organ dysfunction scores such as Pediatric Sequential Organ Failure Assessment (pSOFA), Pediatric Logistic Organ Dysfunction (PeLOD), vasoactive inotrope score, neurological events, immunocompromised status, need for cardiopulmonary resuscitation (CPR), and extracorporeal membrane oxygenation (ECMO) were associated with poor functional outcome
Summary
Sepsis is a state of dysregulated host response to infection and a major cause of mortality and morbidity. Infectious diseases and sepsis-related mortality have decreased globally, the burden remains high in low-middle income countries (LMIC) [1]. Pediatric severe sepsis accounts for >8% of critically ill children with in-hospital mortality around 25%. One-third of children develop progressive organ dysfunction, and nearly one in five survivors show new functional disability [2]. Survivors of sepsis are increasing and continue to require long-term care. Patients recovering from sepsis develop 1-2 new functional limitations with 10–40% cognitive dysfunction [5]. Pediatric sepsis is an important cause of mortality and morbidity in lowand middle-income countries (LMIC), where there is a huge burden of infectious diseases. Despite shortage of resources, adapting protocol-based care has reduced sepsis-related deaths but survivors of pediatric sepsis are at risk of poor functional outcomes
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