Colloids for the Initial Management of Severe Sepsis and Septic Shock in Pediatric Patients

Medeiros, Daniela Nasu Monteiro; Ferranti, Juliana Ferreira; Delgado, Artur Figueiredo; Carvalho, Werther Brunow de

doi:10.1097/pec.0000000000000601

Cited by 24 publications

(13 citation statements)

References 28 publications

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“…The findings of this survey indicates a good, at least presumed, compliance of pediatric intensivists in KSA to the SSC guidelines with regards to fluid resuscitation, and initiation of vasopressors and early antibiotic therapy. Although previous studies have not shown a difference in outcomes when using crystalloids or colloid for fluid resuscitation, 13 , 14 most respondents reported using crystalloids as the first choice for fluid resuscitation. Pediatric intensivists mainly use clinical parameters to assess fluid responsiveness as therapeutic end points (vital signs, urine output and skin perfusion), ScvO 2 , and CVP were second choices for assessment.…”

Section: Discussionmentioning

confidence: 81%

Adherence to surviving sepsis guidelines among pediatric intensivists

Thabet

Zahraa

Chehab

2017

SMJ

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Objectives:To assess the compliance with the 2006 American College of Critical Care-Pediatric Advanced Life Support (ACCM-PALS) guidelines for sepsis management, and the 2012 surviving sepsis campaign (SSC), for the management of pediatric patients with sepsis and to identify the main barriers to adherence to these guidelines.Methods:In November 2015, a prospective cohort study in which a web based electronic survey using a case scenario to explore the usual management of a child with severe sepsis was designed and sent to all consultant pediatric intensivists practicing in Kingdom of Saudi Arabia (KSA). Adherences to 2012 SSC guidelines and to 4 algorithmic time-specific goals outlined in the ACCM-PALS guidelines were measured.Results:Sixty-one (76%) of 80 consultant pediatric intensivists working in KSA responded to the survey. Of the 61 respondents, 94% reported administering antibiotics within one hour of the child presentation, 98% reported starting resuscitation by giving fluid boluses, 93% reported starting vasopressor if the patient remained hypotensive despite fluid resuscitation, and 86% reported they would start hydrocortisone in case of catecholamine refractory shock. In total, 80% of the intensivists reported full adherence to all of the 4 components in the ACCM-PALS bundle; 50% reported that the absence of a locally written protocol was the main barrier to adherence to the SSC guidelines.Conclusion:Pediatric intensivists reported good adherence to the 2006 ACCM-PALS guidelines and 2012 SSC guidelines with some variability in interpretation of the recommendations. The absence of a written protocol was the main reported barrier to adherence to these guidelines.

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Section: Discussionmentioning

confidence: 81%

Adherence to surviving sepsis guidelines among pediatric intensivists

Thabet

Zahraa

Chehab

2017

SMJ

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“…This is because the use of HA as a volume expander in critically ill patients in septic shock is considered safe (Caraceni et al, 2015). However, when comparing the use of colloids (HA) and crystalloids as volume expander, no superiority was found in relation to the effectiveness of the colloid on the crystalloid, so that the crystalloid is recommended as a first choice solution because its lower cost and lower rate of adverse effects (Medeiros et al, 2015). However, in the case of hepatorenal syndrome, the use of HA is already considered a formal indication (Valerio et al, 2016;Bernardi, Ricci, Zaccherini, 2014).…”

Section: Maldistributive Shockmentioning

confidence: 99%

The appropriate use of human albumin in a Brazilian University Hospital: therapeutic indication and dosage regimen

Ishida

Sakai

Melo

2018

Braz. J. Pharm. Sci.

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The objective of the study was to evaluate the use of human albumin in a Brazilian university hospital, in compliance with the institutional protocol and other clinical guidelines, taking into account the therapeutic indications and the dosage regimens. Data was obtained from the pharmacy dispensing records of human albumin, the requests for use it and, when available, the patient's records between January and October 2017. After evaluation the therapeutic indications and the dosage regimens were classified as "appropriate" and "inappropriate". The analysis of 98 requests showed that, when compared to the institutional protocol, 54 (55.1%) requests had an inappropriate therapeutic indication. However, when a comparison was made between 25 medical records (54 requests) and other clinical guidelines, it was observed that the therapeutic indication had none classified as inappropriate. In addition, 16 (29.7%) requests were considered inappropriate in relation to dosage regimens. From these results, it was possible to conclude that although the use of human albumin in the hospital was associated to a clinical protocol, it was outdated. Thus, it is possible to affirm that not only the adoption of a clinical protocol, but its periodical updating is an important strategy to promote the rational use of drugs.

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“…3 Actually, balanced crystalloid solutions are recommended not only in adults but also in pediatric intensive care. [24][25][26][27] The use of crystalloid fluids in neonatology, especially in preterm infants, has to be investigated.…”

Section: Fluid Therapymentioning

confidence: 99%

Neonatal Sepsis: Clinical Considerations

Blatt

Schroth

2017

JCS

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Unspecific symptoms and rapid development of sepsis up to septic shock from systemic inflammatory response syndrome (SIRS) are well-known, important issues in neonatology. A common cause is the infection by Streptococcus agalactiae (Group B Streptococcus [GBS]) or Escherichia coli, which contributes significantly to neonatal morbidity and mortality. Whereas early-onset sepsis is normally derived from mother during birth, late-onset sepsis can be transmitted by the environment. Management of neonatal sepsis includes the maintenance of cardiovascular and pulmonary function besides antibiotic therapy. Due to the fact that until today, there are no reliable screening tests for detecting early sepsis, clinical assessment is considered to be of utmost importance.

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Colloids for the Initial Management of Severe Sepsis and Septic Shock in Pediatric Patients

Cited by 24 publications

References 28 publications

Adherence to surviving sepsis guidelines among pediatric intensivists

Adherence to surviving sepsis guidelines among pediatric intensivists

The appropriate use of human albumin in a Brazilian University Hospital: therapeutic indication and dosage regimen

Neonatal Sepsis: Clinical Considerations

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