Pediatric Sepsis and Septic Shock Management in Resource-Limited Settings

Current Challenges in the Management of Sepsis in ICUs in Resource-Poor Settings and Suggestions for the Future

“…In this review, written by a group of physicians from resource-poor and resourcerich ICUs in LMICs and high-income countries, respectively, who were involved in the development of a series of sets of recommendations for sepsis management in resource-poor settings as recently published [1][2][3][4], the estimated burden, pathogens, and pathophysiology of sepsis are compared between resource-poor and resourcerich settings. The availability of critical care and guidelines and costs of critical care in LMICs are compared to that in high-income countries.…”

Nepal Paediatric Society Clinical Guidance for Management of Sepsis and Septic Shock in the Paediatric Intensive Care Units in Nepal

“…Blood products i. Cross matched packed red blood cells (PRBC), 10 ml/kg may be administered in children with haemoglobin of less than 6 g/dL after two fluid boluses and still hypotensive 3,7 but have no signs of fluid overload (Table 3). Slow blood transfusion is recommended in haemodynamically stable patients only if haemoglobin falls below 4 g/dL.…”

“…Slow blood transfusion is recommended in haemodynamically stable patients only if haemoglobin falls below 4 g/dL. 3,7 ii. Platelets transfusion of 10 ml/kg is only recommended when the level falls below 10 -20,000/mm 3 if patient is not bleeding, or below 50,000 if patient shows some evidence of bleeding.…”

“…Additionally, international sepsis protocols are geared toward high resource nations with differing epidemiology, skills, resources, and practices and may lack relevance to countries like Nepal. 3…”

Less is more, but are we doing enough?

“…We need "less" aerospace medicine for LMICs, and "more" interventions are needed to improve the care and outcomes of ICU patients (Table 1). The intensivists of LMICs should actively participate in the development of recommendations for the treatment of critically ill patients in resource-limited settings such as those developed by the Global Intensive Care Working Group of the European Society of Intensive Care Medicine (ESICM) [10][11][12]. In addition, we must improve the decision-making processes and procedures used in our ICUs.…”