Improved outcomes associated with early resuscitation in septic shock: do we need to resuscitate the patient or the physician?

Abstract

It is clear that early aggressive fluid resuscitation in children with septic shock results in improved survival. Children who receive larger volumes of intravenous isotonic fluid in the initial hour after presentation in septic shock have lower mortality, and children who receive >40 mL/kg of fluid do even better in terms of survival.1 Furthermore, when groups receiving smaller versus larger volumes of intravenous fluids are compared, there is no increase in acute respiratory distress syndrome or noncardiogenic pulmonary edema, 2 significant potential complications of overly-aggressive volume expansion.1 Similar findings are reported by investigators in London from their experiences with a specific type of septic shock, meningiococemia. They also report improved survival when increased fluid resuscitation was instituted as part of early resuscitation therapy.2 In the study reported by Han et al3 in this month’s issue of Pediatrics , investigators now turn their attention to evaluate how well community practitioners have adhered to recently published resuscitation guidelines for the treatment of septic shock in children.4,5 The American College of Critical Care Medicine (ACCM) recently published the Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Patients in Septic Shock, 4 which have been incorporated into the most recent Pediatric Advanced Life Support (PALS) manual.5 The ACCM-PALS …