Pediatric Sepsis Guidelines: summary for resource-limited countries

Abstract

Justification:Pediatric sepsis is a commonly encountered global issue. Existing guidelines for sepsis seem to be applicable to the developed countries, and only few articles are published regarding application of these guidelines in the developing countries, especially in resource-limited countries such as India and Africa.Process:An expert representative panel drawn from all over India, under aegis of Intensive Care Chapter of Indian Academy of Pediatrics (IAP) met to discuss and draw guidelines for clinical practice and feasibility of delivery of care in the early hours in pediatric patient with sepsis, keeping in view unique patient population and limited availability of equipment and resources. Discussion included issues such as sepsis definitions, rapid cardiopulmonary assessment, feasibility of early aggressive fluid therapy, inotropic support, corticosteriod therapy, early endotracheal intubation and use of positive end expiratory pressure/mechanical ventilation, initial empirical antibiotic therapy, glycemic control, and role of immunoglobulin, blood, and blood products.Objective:To achieve a reasonable evidence-based consensus on the basis of published literature and expert opinion to formulating clinical practice guidelines applicable to resource-limited countries such as India.Recommendations:Pediatric sepsis guidelines are presented in text and flow chart format keeping resource limitations in mind for countries such as India and Africa. Levels of evidence are indicated wherever applicable. It is anticipated that once the guidelines are used and outcomes data evaluated, further modifications will be necessary. It is planned to periodically review and revise these guidelines every 3–5 years as new body of evidence accumulates.

Implementing the Emergency Triage, Assessment and Treatment plus admission care (ETAT+) clinical practice guidelines to improve quality of hospital care in Rwandan district hospitals: healthcare workers’ perspectives on relevance and challenges

“…This is consistent with previous research in similar settings [11, 32–34]. For example, a survey of Rwandan district hospitals identified limited availability of resources necessary to provide neonatal and pediatric emergency care (e.g., all hospitals surveyed lacked intra-osseous needles for the management of shock and half of the hospitals evaluated lacked BVM for newborns) [34].…”

“…In Kenya, English and colleagues found that many essential items for the care of severely ill children were lacking in many district hospitals [33]. Likewise, shortages of drugs, equipment, disposable materials as well as facilities made it difficult to implement sepsis management guidelines in Mongolia [32]. While in the ETAT+ training healthcare workers are taught how to correctly assess children with dehydration/shock and how to resuscitate them with fluid, including putting an intra-osseous (IO) line when necessary, our findings and prior research suggest that some of the required equipment are not available in the hospitals and this may therefore hamper successful implementation of the ETAT+ program in Rwanda [34].…”

Clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock from Rohtak, Haryana: A prospective observational study

“…[11] Children who had PICU stay of <6 h, trauma patients, surgical patients, patients transferred from other center were excluded from the study. Children who left against medical advice whose final outcome could not be ascertained were also excluded.…”

“…All patients were managed as per standard clinical guidelines for management of sepsis in children. [11] The management includes placement of central venous catheter, appropriate fluid resuscitation, use of inotropes, empirical antibiotics, and blood component transfusion.…”

Management of children with sepsis and septic shock: a survey among pediatric intensivists of the Réseau Mère-Enfant de la Francophonie

“…The objectives of these recommendations were to standardize patient care and further reduce mortality and morbidity in pediatric sepsis. These guidelines represent best clinical practice; however, stronger evidence is lacking to confirm the components of these recommendations; almost all levels of references and recommendations in pediatric septic shock treatment are low [6-8]. …”