Timing of antibiotics, volume, and vasoactive infusions in children with sepsis admitted to intensive care

Paridon, Bregje M. van; Sheppard, Cathy; G, Garcia Guerra Guerra; Joffe, Ari R.

doi:10.1186/s13054-015-1010-x

Cited by 66 publications

(49 citation statements)

References 47 publications

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“…However, in our current study, we could not demonstrate a durable association of delayed antimicrobial therapy with the longer term outcome of one-year mortality in our primary a priori planned analysis using the common reference group of <1 hour. A recent study by van Paridon et al similarly did not find a significant association between time to antimicrobial therapy and one-year mortality in 79 pediatric patients treated for severe sepsis (30). A notable caveat in our study, however, was that illness severity, oncologic comorbidities, and one-year mortality were higher in the group receiving antimicrobials within 1 hour compared to 1-3 hours.…”

Section: Discussionmentioning

confidence: 92%

Association of Delayed Antimicrobial Therapy with One-Year Mortality in Pediatric Sepsis

Han

Fitzgerald

Balamuth

et al. 2017

Shock

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Objective Delayed antimicrobial therapy in sepsis is associated with increased hospital mortality, but the impact of antimicrobial timing on long-term outcomes is unknown. We tested the hypothesis that hourly delays to antimicrobial therapy are associated with one-year mortality in pediatric severe sepsis. Design Retrospective observational study. Setting Quaternary academic pediatric intensive care unit (PICU) from February 1, 2012 to June 30, 2013. Patients One hundred sixty patients aged ≤21 years treated for severe sepsis. Interventions None. Measurements and Main Results We tested the association of hourly delays from sepsis recognition to antimicrobial administration with one-year mortality using multivariable Cox and logistic regression. Overall one-year mortality was 24% (39 patients), of whom 46% died after index PICU discharge. Median time from sepsis recognition to antimicrobial therapy was 137 min (IQR 65-287). After adjusting for severity of illness and comorbid conditions, hourly delays up to 3 hours were not associated with one-year mortality. However, increased one-year mortality was evident in patients who received antimicrobials ≤1 hour (aOR 3.8, 95% CI 1.2, 11.7) or >3 hours (aOR 3.5, 95% CI 1.3, 9.8) compared to patients who received antimicrobials within 1-3 hours from sepsis recognition. For the subset of patients who survived index PICU admission, antimicrobial therapy ≤1 hour was also associated with increased one-year mortality (aOR 5.5, 95% CI 1.1, 27.4), while antimicrobial therapy >3 hours was not associated with one-year mortality (aOR 2.2, 95% CI 0.5, 11.0). Conclusions Hourly delays to antimicrobial therapy, up to three hours, were not associated with one-year mortality in pediatric severe sepsis in this study. The finding that antimicrobial therapy ≤1 hour from sepsis recognition was associated with increased one-year mortality should be regarded as hypothesis-generating for future studies.

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Section: Discussionmentioning

confidence: 92%

Association of Delayed Antimicrobial Therapy with One-Year Mortality in Pediatric Sepsis

Han

Fitzgerald

Balamuth

et al. 2017

Shock

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“…Clinical markers of cardiac output can include heart rate, capillary refill, and urine output. Although no high-quality RCTs demonstrate clear superiority of this practice, numerous observational studies have reported improved patient outcomes with routine administration of up to 40-60 mL/kg fluid bolus therapy in the first hour of resuscitation [8, 32,33,36,[184][185][186][187]. The panel provides only a weak recommendation for this resuscitation strategy in healthcare systems with availability of intensive care because a more restrictive fluid resuscitation strategy has not been shown to be inferior in this setting and indirect data [183] indicate harm from rapid fluid boluses in other settings.…”

Section: We Recommend Removal Of Intravascular Access Devices That Armentioning

confidence: 99%

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

et al. 2020

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Objectives: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction.Design: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those The Society of Critical Care Medicine guidelines are intended for general information only, are not medical advice, and do not replace professional advice, which should be sought for any medical condition. The full disclaimer for guidelines can be accessed at https ://www.sccm.org/Resea rch/Guide lines /Guide lines . panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. Methods:The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. Results:The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 52 research priorities were identified. Conclusions:A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research. S14 the group heads, panel members, and methodologists. Searches utilized ...

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“…This was also observed by Paridon and colleagues analyzing 79 patients in a single center. 24 It has been suggested that higher fluid volumes are associated with cardiovascular collapse and worse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Bundle Adherence of Intravenous Antibiotic Fluid Resuscitation and Vasopressor in Children with Severe Sepsis or Septic Shock

Barboza¹,

Valete²,

Silva³

2020

Indian Journal of Critical Care Medicine

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Objective: The aim of this study was to measure the effects of a bundle of interventions in children admitted with severe sepsis or septic shock in the first hour after diagnosis on mortality. Materials and methods: A retrospective study was conducted at a pediatric intensive care unit (PICU) between January 2014 and January 2016. Three interventions (intravenous [IV] antibiotic, fluid boluses, and vasopressor administration) applied in the first hour of severe sepsis or septic shock diagnosis were analyzed according to their adherence rates. The main outcome was mortality. Odds ratios were calculated. Results: Of a total of 530 PICU admissions, 105 patients met the criteria for sepsis, 53 (50.5%) with severe sepsis and 52 (49.5%) with septic shock. Seventy-two (68.6%) patients received IV antibiotic within the first hour, 65 (61.9%) received IV fluid bolus, and 55 (53.3%) received a vasopressor drug. Fifty-two (49.5%) patients received concomitant IV antibiotics and fluid bolus. Blood cultures were collected before IV antibiotic administration in 87 (82.9%) out of 105 patients. Thirteen (12.4%) patients died, 1 with severe sepsis and 12 with septic shock. In a univariate analysis, the odds ratios for death and IV antibiotic were 6.39 (p value = 0.081, 95% CI = 0.795-51.465), 4.77 for fluid bolus between 21 and 40 mL/kg (p value = 0.013, 95% CI = 1.395-16.336), and 3.23 for vasopressor administration (p value < 0.0001, 95% CI = 1.734-6.018). In a multivariate analysis, the odds ratio of fluid bolus between 21 and 40 mL/kg was 42.66 (p value = 0.005, 95% CI = 3.117-583.841) and noradrenaline use was 23.93 (p value = 0.010, 95% CI = 2.124-269.750). Conclusion: Adherence was observed for more than half of the single interventions as IV antibiotic, fluid resuscitation, and vasopressor administration in the first hour. The antibiotic administration alone was not associated with high mortality. Vasopressor administration was related to higher mortality but moderate fluid bolus was a protective factor associated with lower mortality.

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Timing of antibiotics, volume, and vasoactive infusions in children with sepsis admitted to intensive care

Cited by 66 publications

References 47 publications

Association of Delayed Antimicrobial Therapy with One-Year Mortality in Pediatric Sepsis

Association of Delayed Antimicrobial Therapy with One-Year Mortality in Pediatric Sepsis

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

Bundle Adherence of Intravenous Antibiotic Fluid Resuscitation and Vasopressor in Children with Severe Sepsis or Septic Shock

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