Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

Abstract

Objectives: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction.Design: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those The Society of Critical Care Medicine guidelines are intended for general information only, are not medical advice, and do not replace professional advice, which should be sought for any medical condition. The full disclaimer for guidelines can be accessed at https ://www.sccm.org/Resea rch/Guide lines /Guide lines . panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. Methods:The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. Results:The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 52 research priorities were identified. Conclusions:A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research. S14 the group heads, panel members, and methodologists. Searches utilized ...

Targeting the eCIRP/TREM-1 Interaction with a Small Molecule Inhibitor Improves Cardiac Dysfunction in Neonatal Sepsis

“…Maintenance of cardiac output is a key predictor of sepsis survival in infants and children and an important therapeutic target. [51][52][53] Additionally, we found that M3 was able to increase left ventricular end diastolic diameter, a characteristic that has also been associated with increased survival. [54,55] As such, we postulated that the myocardial dysfunction in sepsis was due, in part, to eCIRP.…”

The effects of fluid therapy during the first 12 hours from septic shock onset in pediatric patients

“…The American College of Critical Care Medicine (ACCM) treatment guidelines for the rst hour after the diagnosis of severe sepsis rst and foremost recommend an aggressive uid resuscitation of up to 60 mL/kg, followed by the titration of vasoactive medications based on the shock phenotype and, if necessary, additional uids [4,5,11]. Even in the most recent SSC guidelines [6], the uid therapy regimens have not changed. In practicality however, an aggressive resuscitation protocol of up to 60 mL/kg within 60 min is not easy to administer and it is for this reason that there is insu cient time to assess the effects or adverse effects of uid resuscitation in pediatric cases.…”

“…These guidelines were updated in and again in 2017 without signi cant changes to the continued focus on early and aggressive normalization of perfusion, initially using an aggressive volume followed by the addition of vasopressors and inotropes [5]. In 2020, Surviving Sepsis Campaign (SSC) guidelines recommended a 40-60 ml/kg administration of bolus uid over the rst hour if hypotension was present but did not provide distinct recommendations regarding subsequent uid therapy [6].…”

Analysis of mRNA-lncRNA and mRNA-lncRNA-Pathway co-expression networks based on WGCNA in developing pediatric sepsis

“…There are about 1.2 million childhood sepsis cases to be diagnosed globally per year [1]. Unfortunately, mortality was reported to be as high as 25%-50% for children hospitalized for sepsis [2]. The de nition of sepsis has been revised repeatedly, and the latest adult sepsis de nition cannot be rigidly applied to children, so the early diagnosis and appropriate managements essential to improve clinical outcomes for children at risk for sepsis [3].…”