Sepsis is a leading cause of morbidity and mortality in children. Early recognition and timely initiation of empiric broad-spectrum antibiotics and crystalloid fluid administration have been associated with better outcomes. Although evidence for diagnosis and treatment of septic shock was first generated in adult studies, it is clear that pediatric studies are needed for management of septic shock in children. This issue provides guidance for managing septic shock in children, with a focus on early recognition and appropriate resuscitation.
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Following are the most informative references cited in this paper, as determined by the authors.
6. * Paul R, Melendez E, Stack A, et al. Improving adherence to PALS septic shock guidelines. Pediatrics. 2014;133(5):e1358-e1366. (Prospective cohort study; 242 patients) DOI: 10.1542/peds.2013-3871
7. * Weiss SL, Balamuth F, Hensley J, et al. The epidemiology of hospital death following pediatric severe sepsis: when, why, and how children with sepsis die. Pediatr Crit Care Med. 2017;18(9):823-830. (Retrospective observational study; 79 patients) DOI: 10.1097/pcc.0000000000001222
9. * Balamuth F, Weiss SL, Neuman MI, et al. Pediatric severe sepsis in U.S. children’s hospitals. Pediatr Crit Care Med. 2014;15(9):798-805. (Observational cohort study) DOI: 10.1097/pcc.0000000000000225
11. * Weiss SL, Peters MJ, Alhazzani W, et al. Surviving Sepsis Campaign International Guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med. 2020;21(2):e52-e106. (Consensus guideline) DOI: 10.1097/pcc.0000000000002198
13. * Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762-774. (Consensus definition) DOI: 10.1001/jama.2016.0288
14. * Seymour CW, Gesten F, Prescott HC, et al. Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med. 2017;376(23):2235-2244. (Retrospective study; 49,331 patients) DOI: 10.1056/NEJMoa1703058
15. * Evans IVR, Phillips GS, Alpern ER, et al. Association between the New York Sepsis Care Mandate and in-hospital mortality for pediatric sepsis. JAMA. 2018;320(4):358-367. (Cohort study; 1179 patients) DOI: 10.1001/jama.2018.9071
16. * Davis AL, Carcillo JA, Aneja RK, et al. American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med. 2017;45(6):1061-1093. (Consensus guideline) DOI: 10.1097/ccm.0000000000002425
17. * Lane RD, Funai T, Reeder R, et al. High reliability pediatric septic shock quality improvement initiative and decreasing mortality. Pediatrics. 2016;138(4):e20154153. (Retrospective cohort study; 1380 patients) DOI: 10.1542/peds.2015-4153
19. * Balamuth F, Weiss SL, Fitzgerald JC, et al. Protocolized treatment is associated with decreased organ dysfunction in pediatric severe sepsis. Pediatr Crit Care Med. 2016;17(9):817-822. (Retrospective cohort study; 189 patients) DOI: 10.1097/PCC.0000000000000858
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Keywords: shock, septic shock, sepsis, hypotension, sepsis bundle, antibiotics, crystalloid fluids, compensated shock, uncompensated shock, types of shock, warm shock, cold shock, laboratory studies for sepsis, hypotension, fluid resuscitation, shock in immunocompromised patients, airway management, newborn sepsis
Ara Festekjian, MD, MS; Julia Glavinic, MD
Julia K. Lloyd, MD; Louis A. Spina, MD
November 1, 2022
November 1, 2025   CME Information
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Ara Festekjian, MD, MS; Julia Glavinic, MD
Julia K. Lloyd, MD; Louis A. Spina, MD
November 1, 2022
November 1, 2025
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits.
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