Medication and Fluid Management of Pediatric Sepsis and Septic Shock.
Lauren BurgunderCaroline HeyrendJared A OlsonChanelle StidhamRoni D LaneJennifer K WorkmanGitte Y LarsenPublished in: Paediatric drugs (2022)
Sepsis is a life-threatening response to infection that contributes significantly to neonatal and pediatric morbidity and mortality worldwide. The key tenets of care include early recognition of potential sepsis, rapid intervention with appropriate fluids to restore adequate tissue perfusion, and empiric antibiotics to cover likely pathogens. Vasoactive/inotropic agents are recommended if tissue perfusion and hemodynamics are inadequate following initial fluid resuscitation. Several adjunctive therapies have been suggested with theoretical benefit, though definitive recommendations are not yet supported by research reports. This review focuses on the recommendations for medication and fluid management of pediatric sepsis and septic shock, highlighting issues related to antibiotic choices and antimicrobial stewardship, selection of intravenous fluids for resuscitation, and selection and use of vasoactive/inotropic medications. Controversy remains regarding resuscitation fluid volume and type, antibiotic choices depending upon infectious risks in the patient's community, and adjunctive therapies such as vitamin C, corticosteroids, intravenous immunoglobulin, and methylene blue. We include best practice recommendations based on international guidelines, a review of primary literature, and a discussion of ongoing clinical trials and the nuances of therapeutic choices.
Keyphrases
- septic shock
- healthcare
- clinical practice
- clinical trial
- randomized controlled trial
- high dose
- adverse drug
- systematic review
- primary care
- quality improvement
- palliative care
- mental health
- human health
- computed tomography
- emergency department
- low dose
- risk assessment
- intensive care unit
- young adults
- rectal cancer
- locally advanced
- gram negative
- health insurance
- quantum dots