Pediatric Sepsis and Septic Shock Management in Resource-Limited Settings

Excerpt

This chapter provides recommendations on the management of pediatric sepsis in intensive care units (ICUs) in resource-limited settings. Rapidly identification of severe sepsis through a combination of danger signs of end-organ dysfunction or impaired circulation is vital to improve outcome. Better scoring systems for risk stratification tailored for resource-poor settings are needed. Rapid vascular access is critical, and we suggest that in children with septic shock, the placement of an intraosseous line should be considered for vascular access rapidly after an attempt for intravenous access fails. We recommend a careful and individualized approach to fluid administration. For children with severe acute malnutrition without signs of severe shock, we suggest careful administration of intravenous fluids at an initial rate of 10–15 mL/kg/h (no fluid boluses). For well-nourished children who show signs of severely impaired circulation, we suggest careful administration of 10–15 mL/kg of crystalloids over 30–60 min. We recommend incorporation of protocols for timely antibiotic administration, oxygen and respiratory support, and fluid management. We recommend blood transfusion in children with severe anemia and malaria only if there are signs such as respiratory distress or shock or with a hemoglobin concentration below 4 g/dL, requiring rapid transfusion. Children in resource-limited settings with severe respiratory distress and hypoxemia from sepsis could benefit from bubble continuous positive airway pressure (CPAP). Finally, we recommend using a tidal volume of 5–8 mL/kg predicted body weight in all mechanically ventilated children with sepsis-induced lung injury.