Sepsis and Septic Shock in Children: a Review

Abstract

Sepsis incidence is increasing over the years in pediatric intensive care unit. Sepsis and septic shock definition will change compared to the adult medicine, in order to detect the patients in need for early recognition and management. In case of sepsis in a child, oxygen therapy should be started, alongside fluid expansion (up to 40 ml/kg) with isotonic saline solution, antibiotics, and referral to a tertiary care unit. Baseline value and kinetics blood lactate elimination should be assessed as diagnostic and prognostic tools. Multiple organ failure or cardiovascular dysfunction define severe sepsis in pediatrics and their persistence despite fluid expansion define septic shock. In the presence of septic shock including fluid-refractory hypotension, norepinephrine should be started either on peripheral venous or intra-osseous route before central venous access available. Dopamine use should be discouraged. Cardiac ultrasound is the key for hemodynamic management and evaluation of a septic shock patient, either for septic cardiomyopathy detection or fluid expansion guidance. Adjunctive therapies have been advocated in few patients with specific organ dysfunction. Immuno-monitoring is future area of research for detection and treatment of specific complications. The Surviving Sepsis Campaign has helped clinicians worldwide in the management of children with septic shock by implementing detection and management algorithms. A revised version of this campaign is awaited soon.