Challenges of implementing the Paediatric Surviving Sepsis Campaign International Guidelines 2020 in resource-limited settings: A real-world view beyond the academia

Wooldridge, Gavin; O’Brien, Nicole; Muttalib, Fiona; Abbas, Qalab; Appiah, John; Baker, Tim; Bansal, Arun; Basnet, Sangita; Campos-Miño, Santiago; Souza, Daniela Carla de; Rubio, Franco Díaz; Dramowski, Angela; Fernández‐Sarmiento, Jaime; Fustiñana, Ana; González, Gustavo; Jabornisky, Roberto; Jaramillo-Bustamante, Juan Camilo; Kee, Chor Yek; Lang, Hans-Joerg; Lanziotti, Vanessa Soares; Loncarica, Guillermo Kohn; Mohseni-Bod, Hadi; Ode, Bunmi; Murthy, Srinivas; Arnim, Amelie Von Saint Andre – von; Hansmann, Andreas; González‐Dambrauskas, Sebastián

doi:10.32641/andespediatr.v92i6.4030

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…Similarly, other investigators have suggested that the current guidelines for the treatment of paediatric sepsis may not be equally useful in the different regions where sepsis is frequent and that their recommendations should be adjusted to these realities. 22 Several subthemes that emerged in our study can also directly inform future CDS tool design and implementation. Participants emphasised the value of careful clinical assessments that include not only vital signs, but also metrics like perfusion/capillary refill and mental status.…”

Section: Open Accessmentioning

confidence: 88%

“…However, overcoming these challenges may improve dissemination and implementation of paediatric sepsis criteria and ultimately have a greater impact on paediatric sepsis outcomes. Similarly, other investigators have suggested that the current guidelines for the treatment of paediatric sepsis may not be equally useful in the different regions where sepsis is frequent and that their recommendations should be adjusted to these realities 22…”

Section: Discussionmentioning

confidence: 99%

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Clinical decision support tools for paediatric sepsis in resource-poor settings: an international qualitative study

Jimenez-Zambrano,

Ritger,

Rebull

et al. 2023

BMJ Open

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ObjectiveNew paediatric sepsis criteria are being developed by an international task force. However, it remains unknown what type of clinical decision support (CDS) tools will be most useful for dissemination of those criteria in resource-poor settings. We sought to design effective CDS tools by identifying the paediatric sepsis-related decisional needs of multidisciplinary clinicians and health system administrators in resource-poor settings.DesignSemistructured qualitative focus groups and interviews with 35 clinicians (8 nurses, 27 physicians) and 5 administrators at health systems that regularly provide care for children with sepsis, April–May 2022.SettingHealth systems in Africa, Asia and Latin America, where sepsis has a large impact on child health and healthcare resources may be limited.ParticipantsParticipants had a mean age of 45 years, a mean of 15 years of experience, and were 45% female.ResultsEmergent themes were related to the decisional needs of clinicians caring for children with sepsis and to the needs of health system administrators as they make decisions about which CDS tools to implement. Themes included variation across regions and institutions in infectious aetiologies of sepsis and available clinical resources, the need for CDS tools to be flexible and customisable in order for implementation to be successful, and proposed features and format of an ideal paediatric sepsis CDS tool.ConclusionFindings from this study will directly contribute to the design and implementation of CDS tools to increase the uptake and impact of the new paediatric sepsis criteria in resource-poor settings.

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Section: Open Accessmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Clinical decision support tools for paediatric sepsis in resource-poor settings: an international qualitative study

Jimenez-Zambrano,

Ritger,

Rebull

et al. 2023

BMJ Open

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“…); 2) доврачебные факторы (отсроченная диагностика, несо блюдение схем маршрутизации, ограниченные ресурсы медицинского учреждения); 3) факторы стационара (недо статочный штат и объем специализированных услуг, отсутствие оборудования, мониторинга, лекарств). Значительные различия в доступе к здравоохранению, наличии ресурсов, оказании медицинской помощи и ограниченной доказательной базе означают, что многие из имеющихся рекомендаций «Surviving Sepsis Campaign» неп рименимы или невыполнимы в клиниках с ограниченным финансированием [40,41]. По мнению F. Lorton et al (2022), неадекватные мероприятия интенсивной терапии могут быть связаны со следующим:…”

Section: анализ особеннос тей внедрения протоколированного лечения се...unclassified

Adherence to treatment in intensive care units on the example of pediatric sepsis: a review

Миронов

Aleksandrovich

Пшениснов

et al. 2023

Annals of Critical Care

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INTRODUCTION: Intensive care does not always require only a large amount of resources. An important aspect is the formation of a multidisciplinary team involved in the treatment of patients in critical condition. OBJECTIVE: To demonstrate the need for the staff of intensive care units to use protocols for the diagnosis and treatment of critical conditions on the example of sepsis in children. MATERIALS AND METHODS: The analysis of publications devoted to the study of the impact of the implementation of the clinical recommendations of the Surviving Sepsis Campaign for the treatment of sepsis in children on the outcomes of the disease. The articles were searched in the abstract databases PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection and Google Scholar for the period from 2011 to July 2022. Keywords were used: “pediatric sepsis”, “implementation”, “protocolized treatment”, “adherence”. RESULTS: During the search, only thirteen observational studies were found, nine of which were presented retrospectively, which can be attributed to the design flaws of the submitted works. It was revealed that the use of the entire complex of diagnostic and therapeutic measures presented in clinical recommendations and protocols for intensive therapy of sepsis in children can significantly improve the results of treatment, but the commitment of doctors to their use in routine clinical practice remains low and does not exceed 40 %. CONCLUSIONS: The main reason for the lack of commitment to the implementation of recommendations and standards for the treatment of sepsis in children is not only in the presence of organizational obstacles, but also in the absence of reasonable algorithms for its implementation.

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“…Existen diversas guías y protocolos acerca de la administración de fluidos en las Unidades de Cuidados Intensivos (UCI) alrededor del mundo, los cuales brindan información y orientan al personal de salud sobre la manera de administrarlos en pacientes críticos 5,6 . Sin embargo, la forma en la que estos se suministran varía ampliamente entre cada UCI e incluso dentro de las mismas, dependiendo -muchas veces -del criterio específico de cada profesional y disponibilidad, especialmente en situaciones con recursos limitados 1,7,8 .…”

Section: Introductionunclassified

Asociación entre sobrecarga de fluidos y mortalidad en pacientes hospitalizados en una unidad de cuidados intensivos pediatricos

Chávez-Valdivia

Rojas-Vivanco²,

Castañeda³

et al. 2022

Andes pediatr

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Objetivo: Evaluar la asociación entre la sobrecarga de fluido (SF) y mortalidad en pacientes hospitalizados en la Unidad de Cuidados Intensivos Pediátricos (UCIP). Pacientes y Método: Se realizó un estudio de tipo cohortes histórica. Se incluyeron pacientes pediátricos mayores de un mes y menores de 18 años que se encontraban hospitalizados en la UCIP por más de 48 horas durante el año 2016. Se registraron datos demográficos y clínicos. La SF se calculó como [Fluido ingresado (L) - Fluido eliminado (L) /peso al ingreso (Kg)] x 100. Para análisis multivariado, se usó el modelo de regresión de Poisson. Resultados: Se incluyeron 171 pacientes. La mediana de edad fue de 31 meses (RIQ 8;84) y la mortalidad del 8,18%. La SF en la población sobreviviente fue de 7% y 11,5% en la población fallecida (p < 0,05). El análisis ajustado asoció la sobrecarga de fluidos con un mayor riesgo de mortalidad, con un Riesgo Relativo de 1,32 (1,24 -1,40), mientras que edad y valor de la escala de Glasgow se asociaron con menor riesgo. Conclusión: La sobrecarga de fluidos es un factor de riesgo independiente para mortalidad en la población de la Unidad de Cuidados Intensivos Pediátrica.

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Challenges of implementing the Paediatric Surviving Sepsis Campaign International Guidelines 2020 in resource-limited settings: A real-world view beyond the academia

Cited by 5 publications

References 19 publications

Clinical decision support tools for paediatric sepsis in resource-poor settings: an international qualitative study

Clinical decision support tools for paediatric sepsis in resource-poor settings: an international qualitative study

Adherence to treatment in intensive care units on the example of pediatric sepsis: a review

Asociación entre sobrecarga de fluidos y mortalidad en pacientes hospitalizados en una unidad de cuidados intensivos pediatricos

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