Abstract
BackgroundThe Surviving Sepsis Campaign and the American College of Critical Care Medicine guidelines have provided recommendations for the management of pediatric septic shock patients. We conducted a survey among the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) members to assess variations to these recommendations.MethodsA total of 114 pediatric intensive care physicians completed an electronic survey. The survey consisted of four standardized clinical cases exploring seven clinical scenarios.ResultsAmong the seven different clinical scenarios, the types of fluids were preferentially non-synthetic colloids (albumin) and crystalloids (isotonic saline) and volume expansion was not limited to 60 ml/kg. Early intubation for mechanical ventilation was used by 70% of the participants. Norepinephrine was stated to be used in 94% of the PICU physicians surveyed, although dopamine or epinephrine is recommended as first-line vasopressors in pediatric septic shock. When norepinephrine was used, the addition of another inotrope was frequent. Specific drugs such as vasopressin or enoximone were used in < 20%. Extracorporeal life support was used or considered by 91% of the physicians audited in certain specific situations, whereas the use of high-flow hemofiltration was considered for 44%.ConclusionsThis pediatric septic shock management survey outlined variability in the current clinician-reported practice of pediatric septic shock management. As most recommendations are not supported by evidence, these findings outline some limitation of existing pediatric guidelines in regard to context and patient’s specificity.
Highlights
The Surviving Sepsis Campaign and the American College of Critical Care Medicine guidelines have provided recommendations for the management of pediatric septic shock patients
Participants were asked if they would start continuous renal replacement therapy (CRRT). (G) Extracorporeal Life Support (ECLS): participants were asked in different situations if they would start ECLS
The choice of the fluid was albumin (4% or 5%) for 43%, isotonic saline solution for 33%, Ringer lactate for 16% and synthetic colloids for 8% of the respondents. (B) Invasive mechanical ventilation: the decision to intubate the child immediately was taken by 70% of the physicians. (C) Vasopressor: 88% of the respondents would start vasopressor or inotrope immediately after admission, while 12% would administer more fluids first
Summary
The Surviving Sepsis Campaign and the American College of Critical Care Medicine guidelines have provided recommendations for the management of pediatric septic shock patients. We conducted a survey among the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) members to assess variations to these recommendations. Despite an increase in its incidence, only moderate outcome improvements have been reported in critically ill pediatric patients with sepsis in the last decade [1]. The Surviving Sepsis Campaign (SSC) [2, 3] and the American College of Critical Care Medicine (ACCM) [4, 5] have provided recommendations for standardized sepsis management through early recognition and bundles of care, its current impact on mortality is questionable and variability of care has
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