From the Guidelines
Management of Pediatric Septic Shock
Pediatric septic shock is a life-threatening condition that requires immediate recognition and treatment. The initial management involves administration of broad-spectrum antibiotics, such as ceftriaxone (50-75 mg/kg/dose) or meropenem (20 mg/kg/dose), and fluid resuscitation with crystalloids, aiming to achieve a minimum of 40-60 mL/kg in the first hour 1.
Key Components of Management
- Fluid Resuscitation: Initial volume resuscitation commonly requires 40–60 mL/kg but can be as much as 200 mL/kg 1. Fluid infusion is best initiated with boluses of 20 mL/kg, titrated to assuring an adequate blood pressure and clinical monitors of CO including HR, quality of peripheral pulses, capillary refill, level of consciousness, peripheral skin temperature, and urine output.
- Vasoactive Medications: Including dopamine (5-10 mcg/kg/min) or norepinephrine (0.05-0.5 mcg/kg/min), may be initiated to support blood pressure and perfusion, with the goal of maintaining a mean arterial pressure of at least 65 mmHg.
- Hydrocortisone: May be considered for patients with refractory shock, especially if there is suspicion of absolute adrenal insufficiency 1. However, its use is suggested against if adequate fluid resuscitation and vasopressor therapy can restore hemodynamic stability 1.
- Monitoring and Support: Continuous monitoring of vital signs, urine output, and signs of organ dysfunction. Mechanical ventilation may be required for respiratory support.
Important Considerations
- Blood Transfusion: May be considered in patients with severe anemia or those who require blood transfusion to achieve a hemoglobin goal of >10 g/dL to assure ScvO2 >70% 1.
- Fluid Overload: Should be avoided, and diuretics or continuous renal replacement therapy (CRRT) may be used if fluid overload occurs 1.
Overall, the management of pediatric septic shock requires a multifaceted approach that includes prompt recognition, fluid resuscitation, broad-spectrum antibiotics, and supportive care with vasoactive medications and mechanical ventilation as needed.
From the Research
Management of Pediatric Septic Shock
The management of pediatric septic shock involves several key components, including:
- Early recognition and diagnosis of septic shock 2, 3, 4
- Rapid fluid resuscitation to restore adequate tissue perfusion 3, 5, 4
- Administration of broad-spectrum antibiotics to cover likely pathogens 2, 3, 5, 4
- Use of vasoactive/inotropic agents if tissue perfusion and hemodynamics are inadequate following initial fluid resuscitation 5, 6, 4
- Goal-directed therapy to reverse deficits in cellular respiration and improve outcomes 2
Fluid Resuscitation
Fluid resuscitation is a critical component of septic shock management, with recommendations including:
- Use of lactated ringers rather than normal saline due to potential concerns of worse outcomes with a large chloride infusion 3
- A fluid goal of 40-60 ml/kg in the first hour, with careful monitoring for development of fluid overload 3
- Avoidance of excessive fluid administration, which can lead to increased morbidity and mortality 3, 5
Antibiotic Administration
Antibiotic administration is also crucial in the management of pediatric septic shock, with recommendations including:
- Initiation of broad-spectrum antibiotics by the end of the first hour, especially in cases of septic shock 3, 5, 4
- Selection of antibiotics based on likely pathogens and community infectious risks 5
- Consideration of antimicrobial stewardship to minimize resistance and optimize outcomes 5
Vasoactive/Inotropic Agents
Vasoactive/inotropic agents may be necessary in cases where tissue perfusion and hemodynamics are inadequate following initial fluid resuscitation, with options including: