American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock: Erratum

doi:10.1097/ccm.0000000000002573

Cited by 37 publications

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References 233 publications

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“…Nonetheless, high dose corticosteroid administration in septic shock has been associated with higher infection rates, such as disseminated candidiasis and hospital-acquired pneumonia. 19 Other potential side effects include hyperglycemia, bleeding, critical illness associated neuropathy/myopathy, and hypernatremia. 15,19 Corticosteroid use was also associated with suppression of genes corresponding to adaptive immunity.…”

Section: Discussionmentioning

confidence: 99%

“…19 Other potential side effects include hyperglycemia, bleeding, critical illness associated neuropathy/myopathy, and hypernatremia. 15,19 Corticosteroid use was also associated with suppression of genes corresponding to adaptive immunity. 8 In conclusion, we find that a small proportion of pediatric septic shock patients received corticosteroid therapy, mostly hydrocortisone.…”

Section: Discussionmentioning

confidence: 99%

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Corticosteroids for pediatric septic shock patients

Yuniar¹,

Manusita

Low

2019

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Background Septic shock remains a major cause of mortality and admission to the pediatric intensive care unit (PICU) in children. Management includes adequate fluid resuscitation, followed by catecholamine infusion, if needed. Corticosteroid therapy is advised for catecholamine-refractory shock, although this practice is controversial, as it was not beneficial in other studies.Objective To assess corticosteroid use in pediatric septic shock patients in Cipto Mangunkusumo Hospital.Methods This cross-sectional study included all patients aged 1 month-18 years with a diagnosis of septic shock during the study period of January 2014 to July 2018 admitted in PICU Dr. Cipto Mangunkuskumo Hospital, Jakarta. Data obtained from medical records were, age, sex, immunology status, port d'entrée of sepsis, inotropic and vasopressor usage, mechanical ventilation, corticosteroid type, hospital length of stay (LoS), and mortality outcome. ResultsOf 217 children with septic shock, 12 patients (5.5%) received corticosteroid therapy. The most common corticosteroid given was hydrocortisone (80%), with a 2 mg/kg BW loading dose, followed by a continuous infusion dose of 2-50 mg/kg BW/day. Almost all patients (11/12) received corticosteroid therapy until they died. Median duration of corticosteroid use was 2 (range 1-7) days, median number of inotropes and vasopressors used was 3 (range 2-4) agents, median LoS was 3 (range 1-9) days, and mortality rate was 100%.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Corticosteroids for pediatric septic shock patients

Yuniar¹,

Manusita

Low

2019

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“…The study will recruit across four tertiary Emergency Departments (ED) and Paediatric Intensive Care Units (PICU) of participating sites in Queensland, Australia. The trial compares early inotropes defined as adrenaline infusion started after 20 mL/kg fluid resuscitation, with standard care defined as providing up to 40-60 mL/kg fluid resuscitation prior to initiation of inotropes (11,13) (20).…”

Section: Study Design and Settingmentioning

confidence: 99%

“…Recent recommendations for treatment of sepsis and septic shock in children include the American College of Critical Care Medicine clinical practice parameters (13), and the 2020 paediatric Surviving Sepsis Campaign (SSC) guidelines (11). While both advocate for the administration of 40-60 mL/kg of fluid bolus therapy prior to the commencement of intravenous inotropes, the 2020 SSC added caution for fluid bolus therapy if intensive care resources are unavailable given the evidence towards worse survival in children with severe infections observed in the Fluid Expansion as Supportive Therapy (FEAST) study (14).…”

Section: Introductionmentioning

confidence: 99%

Early Resuscitation in Paediatric Sepsis Using Inotropes – A Randomised Controlled Pilot Study in the Emergency Department (RESPOND ED): Study Protocol and Analysis Plan

et al. 2021

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Introduction: Septic shock in children still carries substantial mortality and morbidity. While resuscitation with 40–60 mL/kg intravenous fluid boluses remains a cornerstone of initial resuscitation, an increasing body of evidence indicates potential for harm related to high volume fluid administration. We hypothesize that a protocol on early use of inotropes in children with septic shock is feasible and will lead to less fluid bolus use compared to standard fluid resuscitation. Here, we describe the protocol of the Early Resuscitation in Paediatric Sepsis Using Inotropes – A Randomised Controlled Pilot Study in the Emergency Department (RESPOND ED).Methods and analysis: The RESPOND ED study is an open label randomised controlled, two arm, multicentre pilot study conducted at four specialised paediatric Emergency Departments. Forty children aged between 28 days and 18 years treated for presumed septic shock will be randomized in a 1:1 ratio to early inotropes vs. standard fluid resuscitation. Early inotrope treatment is defined as the commencement of a continuous intravenous adrenaline infusion after 20 mL/kg fluid bolus resuscitation. Standard fluid resuscitation is defined as delivery of 40 to 60 mL/kg fluid bolus resuscitation prior to commencement of inotropes. In addition to feasibility outcomes, survival free of organ dysfunction censored at 28 days will be assessed as the main clinical outcome. The study cohort will be followed up at 28 days, and at 6 months post enrolment to assess quality of life and functional status. Biobanking nested in the study cohort will be performed to enable ancillary biomarker studies.Ethics and dissemination: The trial has ethical clearance (Children's Health Queensland, Brisbane, HREC/18/QCHQ/49168) and is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12619000828123). Enrolment commenced on July 21st, 2019. The primary manuscript will be submitted for publication in a peer-reviewed journal.Trial Registration: Australian and New Zealand Clinical Trials Registry, ACTRN12619000828123.

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“…The clinical guidelines comprised rapid identification of sepsis, management with fluid resuscitation and antibiotic administration in the first hour, and intensive care hemodynamic support with source control (7). These guidelines were revised in 2007 and 2014 (8,9). In addition, the Surviving Sepsis Campaign (SSC) published the first pediatric guidelines in 2020 (10).…”

Section: Introductionmentioning

confidence: 99%

Association of Antibiotics Administration Timing With Mortality in Children With Sepsis in a Tertiary Care Hospital of a Developing Country

et al. 2020

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Objective: To investigate the association between antibiotics administration timing with morbidity and mortality in children with severe sepsis and septic shock, presenting to a tertiary care center in a developing country. Methods: This is a retrospective study of children aged 14 years or younger diagnosed with severe sepsis or septic shock at a free-standing tertiary children's hospital in Saudi Arabia between April 2015 and February 2018. We investigated the association between antibiotic administration timing and pediatric intensive care unit (PICU) mortality, PICU length of stay (LOS), hospital LOS, and ventilation-free days after adjusting for confounders. Results: Among the 189 admissions, 77 patients were admitted with septic shock and 112 with severe sepsis. Overall, the mortality rate was 16.9%. The overall median time from sepsis recognition to antibiotic administration was 105 min (IQR: 65-185.5 min); for septic shock patients, it was 85 min (IQR: 55-148 min), and for severe sepsis, 130 min (IQR: 75.5-199 min). Delayed antibiotic administration (> 3 h) was associated with 3.85 times higher PICU mortality (95% confidence intervals 1.032-14.374) in children with septic shock than in children who receive antibiotics within 3 h, after controlling for severity of illness, age, comorbidities, and volume resuscitation. However, delayed antibiotics administration was not significantly associated with higher PICU mortality in children diagnosed with severe sepsis. Conclusions: Delayed antibiotics administration in children with septic shock admitted to a free-standing children's hospital in a developing country was associated with PICU mortality.

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American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock: Erratum

Abstract: Background: The American College of Critical Care Medicine (ACCM) provided 2002 and 2007 guidelines for hemodynamic support of newborn and pediatric septic shock.

Cited by 37 publications

References 233 publications

Corticosteroids for pediatric septic shock patients

Corticosteroids for pediatric septic shock patients

Early Resuscitation in Paediatric Sepsis Using Inotropes – A Randomised Controlled Pilot Study in the Emergency Department (RESPOND ED): Study Protocol and Analysis Plan

Association of Antibiotics Administration Timing With Mortality in Children With Sepsis in a Tertiary Care Hospital of a Developing Country

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