Septic shock in pediatrics: the state-of-the-art

Abstract

Objective: Review the main aspects of the definition, diagnosis, and management of pediatric patients with sepsis and septic shock.

Source of data: A search was carried out in the MEDLINE and Embase databases. The articles were chosen according to the authors' interest, prioritizing those published in the last five years.

Synthesis of data: Sepsis remains a major cause of mortality in pediatric patients. The variability of clinical presentations makes it difficult to attain a precise definition in pediatrics. Airway stabilization with adequate oxygenation and ventilation if necessary, initial volume resuscitation, antibiotic administration, and cardiovascular support are the basis of sepsis treatment. In resource-poor settings, attention should be paid to the risks of fluid overload when administrating fluids. Administration of vasoactive drugs such as epinephrine or norepinephrine is necessary in the absence of volume response within the first hour. Follow-up of shock treatment should adhere to targets such as restoring vital and clinical signs of shock and controlling the focus of infection. A multimodal evaluation with bedside ultrasound for management after the first hours is recommended. In refractory shock, attention should be given to situations such as cardiac tamponade, hypothyroidism, adrenal insufficiency, abdominal catastrophe, and focus of uncontrolled infection.

Conclusions: The implementation of protocols and advanced technologies have reduced sepsis mortality. In resource-poor settings, good practices such as early sepsis identification, antibiotic administration, and careful fluid infusion are the cornerstones of sepsis management.

Keywords: Child; Choque; Criança; Infection; Infecção; Intensive Care Units; Mortalidade; Mortality; Sepse; Sepsis; Shock; Unidade de Cuidados Intensivos.

Figure 1

Simplified pharmacological support scheme for children with septic shock. See details in the text. BP, blood pressure; CI, cardiac index; ECMO, extracorporeal membrane oxygenation. Modified from Davis et al.

Figure 2

Summary of best practices and targets in septic shock. Adapted from Ames et al. SIRS, systemic inflammatory response syndrome; BP, blood pressure; CFT, capillary filling time; MAP, mean blood pressure; CVP, central venous pressure; CI, cardiac index; SVCO₂, central venous oxygen saturation.