High Reliability Pediatric Septic Shock Quality Improvement Initiative and Decreasing Mortality

Abstract

QI methodology improved septic shock program goal adherence and decreased mortality without increasing PICU admissions or PED length of stay over the 8-year period, supporting continued emphasis on early recognition, timely IVF resuscitation, and antibiotic administration.

Feasibility of continuous temperature monitoring in pediatric immunocompromised patients: A pilot study

“…Sepsis remains a major cause of death in pediatric HSCT recipients and oncology patients with a mortality rate of up to 30% in patients admitted to the intensive care unit (ICU) . Current methodologies to reduce mortality from sepsis in pediatric HSCT recipients and oncology patients focus on standardization of care to improve timeliness to administration of antibiotics . Mortality rates were significantly reduced when antibiotics were administered within 1 h of fever detection in patients with severe sepsis and septic shock .…”

“…BSI occur in nearly 30% of patients undergoing HSCT and are associated with prolonged hospitalization, septic shock, increased rates of intensive care admission, prolonged antibiotic treatment, and increased mortality . Fever is often the first symptom of sepsis, and initiation of broad‐spectrum antibiotics within 60 min of recognition of sepsis or septic shock has been shown to improve morbidity and mortality . Considering the impact of sepsis on patient outcomes and the health care system, comprehensive management strategies have been developed to improve early recognition and timely interventions in pediatric patients .…”

“…2,[4][5][6][7][8][9][10][11] Fever is often the first symptom of sepsis, 12,13 and initiation of broad-spectrum antibiotics within 60 min of recognition of sepsis or septic shock has been shown to improve morbidity and mortality. [12][13][14] Considering the impact of sepsis on patient outcomes and the health care system, comprehensive management strategies have been developed to improve early recognition and timely interventions in pediatric patients. 14,15 Early detection of fever and prompt use of broad-spectrum antibiotics is crucial in immunocompromised patients.…”

Paediatric sepsis: old wine in new bottles?

“…Implementation of a sepsis protocol results in shorter time to first intravenous fluid and antibiotics administration as well as reduced time to vasoactive infusion [9–12]. Management of children with a sepsis protocol, based on SCCM-PALS guidelines, aiming to timely deliver antibiotics, adequate intravenous fluid resuscitation and vasoactive agents, has been shown to be associated with a decreased mortality [13, 14], a reduced length of hospital and PICU stay [10, 14], and a reduced number of children with organ dysfunction (Table 1) [8]. Increased compliance with sepsis bundles in paediatric emergency departments was associated with improved outcomes, highlighting the importance of bundle implementation and maintenance for performance metrics [15].…”

The authors reply

“…This likely makes the care of these patients more generalizable to centers who have not yet achieved perfect guideline adherence, an ideal state that has been published from only two centers over a limited time period (5, 6). …”