The management of septic shock in children: controversies and certainties

Abstract

Despite the progress in vaccinology, antibiotic therapy and intensive care, the sepsis and septic shock in children remain a major cause of morbidity and mortality worldwide, mainly in countries with low medical resources. Therefore, efforts have been made for implementation of worldwide protocols considering the management of septic shock in infants. The definitions of sepsis, septic shock and multiple organ dysfunction syndrome (MODS) are similar with the conditions present in adults, the difference consisting in the values of heart rate, respiratory frequency and leukocytes. The management of septic shock in children was detailed in “Surviving Sepsis Campaign” (SSCG) since 2005 and subsequent periodically reviewed. However, most of these recommendations were based on the general agreement of specialists without serious evidence or just based on studies conducted on adults. Therefore, in recent years we witness a change in the management of septic shock at pediatric age, from standardized protocols to a personalized therapy. Moreover, the most recent version of SSCG (2016) has not included the specific recommendations for this age group. In this article we tried to summarize the latest evidence gathered on the management of septic shock in children.