Executive summary: surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

Weiss, Scott L.; Peters, Mark; Alhazzani, Waleed; Agus, Michael S. D.; Flori, Heidi R.; Inwald, David; Nadel, Simon; Schlapbach, Luregn J.; Tasker, Robert C.; Argent, Andrew C.; Brierley, Joe; Carcillo, Joseph A.; Carrol, Enitan D.; Carroll, Christopher L.; Cheifetz, Ira M.; Choong, Karen; Cies, Jeffry J.; Cruz, Andrea T.; Luca, Danièle De; Deep, Akash; Faust, Saul N.; Oliveira, Cláudio Flauzino de; Hall, Mark W.; Ishimine, Paul; Javouhey, Étienne; Joosten, Koen; Joshi, Poonam; Karam, Oliver; Kneyber, Martin C. J.; Lemson, Joris; MacLaren, Graeme; Mehta, Nilesh M.; Møller, Morten Hylander; Newth, Christopher J. L.; Nguyen, Trung C.; Nishisaki, Akira; Nunnally, Mark; Parker, Margaret M.; Paul, Raina; Randolph, Adrienne G.; Ranjit, Suchitra; Romer, Lewis H.; Scott, Halden F.; Tume, Lyvonne N; Verger, Judy; Williams, Eric A.; Wolf, Joshua; Wong, Hector R.; Zimmerman, Jerry J.; Kissoon, Niranjan; Tissières, Pierre

doi:10.1007/s00134-019-05877-7

Cited by 42 publications

(30 citation statements)

References 7 publications

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“…Nevertheless, a previous study suggests that the lowest SCr within the rst week in the ICU better approximates the true baseline distribution and leads to more accurate diagnosis of AKI, as compared with the estimation methods of back-calculating baseline SCr [39]. Second, although it is a challenge to evaluate the performance of biological indicators on the diagnosis of septic AKI based on the recommendations applying to children [26,32] and the relevance of this nding of uCXCL10 in predicting septic AKI is limited by the small sample size, the diagnostic accuracy of uCXCL10 persisted in all critically ill children and in a subgroup analysis of children with sepsis. Third, we did not perform an etiological analysis for developing AKI.…”

Section: Discussionmentioning

confidence: 99%

“…Sepsis was diagnosed by a chief physician and two attending physicians specialized in pediatric critical care medicine, who were completely blinded to the urinary biomarker results, retrospectively, in accordance with the international guidelines for management of septic shock and sepsis-associated organ dysfunction in children (Surviving Sepsis Campaign International Guidelines) [26].…”

Section: Diagnosis Of Sepsismentioning

confidence: 99%

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Urinary CXCL10 is Associated with Acute Kidney Injury and Sepsis, and Predicts Mortality in Critically Ill Children

Huang¹,

Zhou²,

Wang³

et al. 2020

Preprint

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Background: Acute kidney injury (AKI) biomarkers are often susceptible to confounding factors, limiting their utility as a specific biomarker, in the prediction of AKI, especially in heterogeneous population. The urinary CXC motif chemokine 10 (uCXCL10), as an inflammatory mediator, has been proposed to be a biomarker for AKI in a specific setting. Whether uCXCL10 is associated with AKI and predicts AKI in critically ill patients remains unclear. The aims of the study were to investigate clinical variables potentially associated with uCXCL10 levels and determine the associations of uCXCL10 with AKI, sepsis and PICU mortality in critically ill children, as well as its predictive values of aforementioned issues. Methods: Urinary CXCL10 levels were serially measured in a heterogeneous group of children during the first week after pediatric intensive care unit (PICU) admission. AKI diagnosis was based on the criteria of Kidney Disease: Improving Global Outcomes with serum creatinine and urine output. Sepsis was diagnosed according to surviving sepsis campaign international guidelines for children. Mortality was defined as all-cause death occurring during the PICU stay.Results: Among 342 critically ill children, 52 (15.2%) developed AKI during the first week after PICU admission, and 132 (38.6%) were diagnosed as sepsis and 30 (12.3%) died during PICU stay. Both the initial and peak values of uCXCL10 remained independently associated with AKI with adjusted odds ratios (AORs) of 1.791 (P = 0.010) and 2.002 (P = 0.002), sepsis with AORs of 1.679 (P = 0.003) and 1.752 (P = 0.002), septic AKI with AORs of 3.281 (P <0.001) and 3.172 (P <0.001), and PICU mortality with AORs of 2.779 (P = 0.001) and 3.965 (P <0.001), respectively. The AUCs of the initial uCXCL10 for predicting AKI, sepsis, septic AKI, and PICU mortality were 0.63 (0.53-0.72), 0.62 (0.56-0.68), 0.75 (0.64-0.87), and 0.77 (0.68-0.86), respectively. The AUCs for prediction by using peak uCXCL10 were as follows: AKI 0.65 (0.56-0.75), sepsis 0.63 (0.57-0.69), septic AKI 0.76 (0.65-0.87), and PICU mortality 0.84 (0.76-0.91).Conclusions: Urinary CXCL10 is independently associated with AKI and sepsis, and may be a potential indicator of septic AKI and PICU mortality in critically ill children.

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Section: Discussionmentioning

confidence: 99%

Section: Diagnosis Of Sepsismentioning

confidence: 99%

Urinary CXCL10 is Associated with Acute Kidney Injury and Sepsis, and Predicts Mortality in Critically Ill Children

Huang¹,

Zhou²,

Wang³

et al. 2020

Preprint

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“…The summary of this EvUp is more detailed than for other EvUps owing to the critical nature of these new findings and in acknowledgment of the 2020 publication of new guidelines for the management of infants and children with septic shock. 26 …”

Section: Pals: Recognition and Treatment Of Septic Shockmentioning

confidence: 99%

“…If the infant or child is not hypotensive and is in a system without the availability of intensive care, the authors recommend against bolus fluid administration but to start maintenance fluids. 26 …”

Section: Pals: Recognition and Treatment Of Septic Shockmentioning

confidence: 99%

“…Of note, the 2020 surviving sepsis guidelines 26 suggest the use of epinephrine or norepinephrine compared with dopamine based on very-low-quality evidence. The authors state that they could not make a recommendation for a first-line vasoactive infusion for septic shock, noting that in their practices they use epinephrine or norepinephrine.…”

Section: Pals: Recognition and Treatment Of Septic Shockmentioning

confidence: 99%

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Pediatric Life Support

Maconochie¹,

Aickin²,

Hazinski³

et al. 2020

Resuscitation

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This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) for pediatric life support is based on the most extensive evidence evaluation ever performed by the Pediatric Life Support Task Force. Three types of evidence evaluation were used in this review: systematic reviews, scoping reviews, and evidence updates. Per agreement with the evidence evaluation recommendations of the International Liaison Committee on Resuscitation, only systematic reviews could result in a new or revised treatment recommendation. Systematic reviews performed for this 2020 CoSTR for pediatric life support included the topics of sequencing of airway-breaths-compressions versus compressions-airway-breaths in the delivery of pediatric basic life support, the initial timing and dose intervals for epinephrine administration during resuscitation, and the targets for oxygen and carbon dioxide levels in pediatric patients after return of spontaneous circulation. The most controversial topics included the initial timing and dose intervals of epinephrine administration (new treatment recommendations were made) and the administration of fluid for infants and children with septic shock (this latter topic was evaluated by evidence update). All evidence reviews identified the paucity of pediatric data and the need for more research involving resuscitation of infants and children.

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Melatonin effects on sleep quality and outcomes of COVID‐19 patients: An open‐label, randomized, controlled trial

Mousavi

Heydari

Mehravaran

et al. 2021

Journal of Medical Virology

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This trial aims to evaluate the effectiveness of adding melatonin to the treatment protocol of hospitalized coronavirus disease 2019 patients. This was an open-label, randomized controlled clinical trial in hospitalized COVID-19 patients. Patients were randomized into a treatment arm receiving melatonin plus standard care or a control arm receiving standard care alone. The trial's primary endpoint was sleep quality examined by the Leeds Sleep Evaluation Questionnaire (LSEQ). The trial's secondary endpoints were symptoms alleviation by Day 7, intensive care unit admission, 10-day mortality, white blood cell count, lymphocyte count, C-reactive protein status, and peripheral capillary oxygen saturation. Ninety-six patients were recruited and allocated to either the melatonin arm (n = 48) or control arm (n = 48).Baseline characteristics were similar across treatment arms. There was no significant difference in symptoms on Day 7. The mean of the LSEQ scores was significantly higher in the melatonin group (p < 0.001). There was no significant difference in laboratory data, except for blood oxygen saturation, which has improved significantly in the melatonin group compared with the control group (95.81% vs. 93.65% respectively, p = 0.003). This clinical trial study showed that the combination of oral melatonin tablets and standard treatment could substantially improve sleep quality and blood oxygen saturation in hospitalized COVID-19 patients.

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Executive summary: surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

Cited by 42 publications

References 7 publications

Urinary CXCL10 is Associated with Acute Kidney Injury and Sepsis, and Predicts Mortality in Critically Ill Children

Urinary CXCL10 is Associated with Acute Kidney Injury and Sepsis, and Predicts Mortality in Critically Ill Children

Pediatric Life Support

Melatonin effects on sleep quality and outcomes of COVID‐19 patients: An open‐label, randomized, controlled trial

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