Septic shock in pediatrics: the state-of-the-art

García, Pedro Celiny Ramos; Tonial, Cristian Tedesco; Piva, Jefferson Pedro

doi:10.1016/j.jped.2019.10.007

Cited by 40 publications

(45 citation statements)

References 70 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although the authors noted that their definition required improvement, pediatric specialists began using it in daily PICU practice worldwide [16,17]. Regardless of the wide acceptance of the IPSCC definition in clinical settings, several studies have demonstrated its limitations [18,19]. As shown in this large multicenter study [19], there was little consensus (46%) between the possible diagnosis of severe sepsis by the attending physician and the diagnosis according to the IPSCC definition.…”

Section: Discussionmentioning

confidence: 99%

“…In order to obtain bacteriological/virological surveillance of our patients, we use C-reactive protein (CRP) as the firstline inflammatory biomarker. This biomarker is one of the most used in PICUs worldwide [18]. But there are known limitations in this diagnostic pathway, mainly due to the low sensitivity in differentiating cases of severe sepsis and common bacterial infections in an isolated measurement [36].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pediatric infection and sepsis in five age subgroups: single-center registry

Hermon

Etmayr

Brandt

et al. 2020

Wien Med Wochenschr

View full text Add to dashboard Cite

Summary Background Sepsis is, worldwide, one of the leading causes of death among infants and children. Over the past two decades, mortality rates have declined due to advanced treatment options; however, the incidence of sepsis and septic shock is still on the rise in many hospital settings. The objective of this study was to evaluate the course of this disease in pediatric intensive care patients. Methods An evaluation of pediatric patients in the intensive care unit diagnosed with infections or sepsis between 2005 and 2015 was performed via a retrospective exploratory data analysis. Results During the observational period, 201 patients were diagnosed with infection or sepsis. The study population was divided into five age subgroups. The majority of patients were newborns, infants, and toddlers. Forty percent had sepsis; 6% had septic shock. Viral infection was the most prevalent (59%). The overall survival rate was 83%; newborns and adolescents had the lowest survival rates. Conclusion With this registry, children divided into five age subgroups with infection or sepsis were evaluated and treatment strategies were examined. We have shown that our findings on children treated in our pediatric intensive care unit conform with current literature about pediatric sepsis. In addition to maintaining strict hygiene standards, optimal aspects of sepsis care should be stringently observed, such as the quick administration of empirical broad-spectrum antibiotics, initial adequate fluid resuscitation, and a reliable and frequent routine of source control.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pediatric infection and sepsis in five age subgroups: single-center registry

Hermon

Etmayr

Brandt

et al. 2020

Wien Med Wochenschr

View full text Add to dashboard Cite

show abstract

“…Sepsis and septic shock represent a major cause of ICU admission and mortality among critically ill paediatric patients ( Garcia et al, 2020 ). The American College of Critical Medicine/Pediatric Advanced Life Support protocol recommends the administration of antibiotic therapy within the first hours of sepsis diagnosis ( Davis et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

A Proof of Concept of the Role of TDM-Based Clinical Pharmacological Advices in Optimizing Antimicrobial Therapy on Real-Time in Different Paediatric Settings

et al. 2021

View full text Add to dashboard Cite

Introduction: Antimicrobial treatment is quite common among hospitalized children. The dynamic age-associated physiological variations coupled with the pathophysiological alterations caused by underlying illness and potential drug-drug interactions makes the implementation of appropriate antimicrobial dosing extremely challenging among paediatrics. Therapeutic drug monitoring (TDM) may represent a valuable tool for assisting clinicians in optimizing antimicrobial exposure. Clinical pharmacological advice (CPA) is an approach based on the correct interpretation of the TDM result by the MD Clinical Pharmacologist in relation to specific underlying conditions, namely the antimicrobial susceptibility of the clinical isolate, the site of infection, the pathophysiological characteristics of the patient and/or the drug-drug interactions of cotreatments. The aim of this study was to assess the role of TDM-based CPAs in providing useful recommendations for the real-time personalization of antimicrobial dosing regimens in various paediatric settings.Materials and methods: Paediatric patients who were admitted to different settings of the IRCCS Azienda Ospedaliero-Universitaria of Bologna, Italy (paediatric intensive care unit [ICU], paediatric onco-haematology, neonatology, and emergency paediatric ward), between January 2021 and June 2021 and who received TDM-based CPAs on real-time for personalization of antimicrobial therapy were retrospectively assessed. Demographic and clinical features, CPAs delivered in relation to different settings and antimicrobials, and type of dosing adjustments were extracted. Two indicators of performance were identified. The number of dosing adjustments provided over the total number of delivered CPAs. The turnaround time (TAT) of CPAs according to a predefined scale (optimal, <12 h; quasi-optimal, between 12–24 h; acceptable, between 24–48 h; suboptimal, >48 h).Results: Overall, 247 CPAs were delivered to 53 paediatric patients (mean 4.7 ± 3.7 CPAs/patient). Most were delivered to onco-haematological patients (39.6%) and to ICU patients (35.8%), and concerned mainly isavuconazole (19.0%) and voriconazole (17.8%). Overall, CPAs suggested dosing adjustments in 37.7% of cases (24.3% increases and 13.4% decreases). Median TAT was 7.5 h (IQR 6.1–8.8 h). Overall, CPAs TAT was optimal in 91.5% of cases, and suboptimal in only 0.8% of cases.Discussion: Our study provides a proof of concept of the helpful role that TDM-based real-time CPAs may have in optimizing antimicrobial exposure in different challenging paediatric scenarios.

show abstract

“…A sepse pode ser definida como uma falência multiorgânica fatal decorrente de uma resposta desregulada do organismo diante de um processo infeccioso (8) . Entretanto, de acordo com o Instituto Latino Americano de Sepse (ILAS), no que diz respeito à população pediátrica, não havia, até 2005, uma concordância em relação às definições de sepse devido às particularidades da infância.…”

Section: Introductionunclassified

“…Apesar desses grandes avanços, a sepse ainda permanece como uma das principais causas de óbito em crianças, tanto em países subdesenvolvidos como em países em desenvolvimento (9) . Dessa forma, impacta diretamente a recuperação de pacientes pediátricos, visto que suas manifestações em formas mais graves podem chegar a uma alta taxa de morbimortalidade devido a diversos fatores que incluem desde a cobertura vacinal deficiente até a falta de elaboração e adoção de protocolos atualizados pelas instituições hospitalares (8) .…”

Section: Introductionunclassified

Infecção relacionada à assistência à saúde e sepse na hospitalização em pediatria

et al. 2021

View full text Add to dashboard Cite

Introdução: As infecções em pediatria são entraves no tratamento da criança hospitalizada, pois amplificam a morbidade e mortalidade, o tempo de permanência hospitalar, os custos e o sofrimento do paciente e sua família. Objetivo: investigar a frequência das infecções relacionadas à assistência à saúde e sepse em crianças hospitalizadas. Método: Trata-se de um estudo quantitativo, prospectivo e analítico. Os dados clínico-epidemiológicos foram obtidos por meio de 173 prontuários físicos e os resultados das culturas e antibiogramas foram coletados nos respectivos prontuários eletrônicos dos pacientes. Os dados foram analisados via Microsoft Office Excel® e análise descritiva. Resultados: Identificou-se uma alta prevalência de infecções relacionadas à assistência à saúde com 31% (n= 54) e destas 55% desenvolveram sepse (n= 32). Conclusão: Os achados permitem uma reflexão das práticas assistenciais executadas, bem como medidas que podem ser adotadas para sua melhoria, visando a diminuição dos índices de infecção dentro dos serviços de saúde com ênfase na população pediátrica.

show abstract

Septic shock in pediatrics: the state-of-the-art

Cited by 40 publications

References 70 publications

Pediatric infection and sepsis in five age subgroups: single-center registry

Pediatric infection and sepsis in five age subgroups: single-center registry

A Proof of Concept of the Role of TDM-Based Clinical Pharmacological Advices in Optimizing Antimicrobial Therapy on Real-Time in Different Paediatric Settings

Infecção relacionada à assistência à saúde e sepse na hospitalização em pediatria

Contact Info

Product

Resources

About