Management of septic shock in childhood

Abstract

Septic shock remains a leading cause of morbidity and mortality in children. Early administration of empirical antibiotic therapy reduces mortality. The keystone of resuscitation is aggressive volume replacement. Adjunctive therapies to modulate the inflammatory response may further enhance outcome, but do not replace principles of resuscitation.

Adenoviral delivery of the β2-adrenoceptor gene in sepsis: a subcutaneous approach in rat for kidney protection

“…It was of concern that, although administration of adeno-β 2 -AR effectively supported renal function, gene therapy was not able to protect all of the endotoxaemic animals. Therefore gene therapy and adjuvant therapies with recombinant human activated protein C and early administration of empirical antibiotic therapy may be also required to improve the survival of the patients with sepsis [20].…”

Fatal Haemophilus influenzae type a sepsis in an infant

“…Ceftriaxone (100 mg/kg) was administered and fluid and blood product resuscitation was commenced via two intraosseus lines. Dobutamine, noradrenaline, adrenaline and vasopressin infusions were all utilised to provide inotropic support, and hydrocortisone was given for its potential benefit in reversing some of the effects of shock . The infant remained haemodynamically unstable and required ongoing crystalloid and colloid boluses, along with repeated transfusions of packed red blood cells, fresh frozen plasma and platelets.…”

“…This was not the case before 1993 Staphylococcus aureus False: Staphylococcal meningitis is rare in previously well children. For which of the following interventions has the greatest mortality benefit been proven in cases of severe sepsis in children? Early administration of empiric antibioticsTrue: Early administration of antibiotics has been shown by many studies to reduce mortality in septic shock in children Endotracheal intubationFalse: Airway management is fundamental to resuscitation and endotracheal intubation is often required.…”

“…Endotracheal intubationFalse: Airway management is fundamental to resuscitation and endotracheal intubation is often required. The evidence for a mortality benefit related to timing of antibiotic therapy means that in sepsis, priority should be given to early initiation of antibiotics even while resuscitation is taking place Fluid resuscitationFalse: Volume replacement is considered a crucial aspect of resuscitation in septic shock, but indiscriminate use of fluid boluses in septic shock has recently been challenged.…”

“…All were treated in resource‐limited settings and rates of malaria were high, so the implications for practice in other settings remain unclear . Regardless of what fluid therapy is indicated, the evidence for a mortality benefit related to timing of antibiotic therapy means that priority should be given to early initiation of antibiotics even while resuscitation is taking place Administration of corticosteroidsFalse: Corticosteroid therapy remains controversial, but is probably indicated at physiologic replacement doses in children with no signs of reversal of shock in spite of high doses of inotropes …”