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VOLUME 14 , ISSUE 1 ( January, 2010 ) > List of Articles

Educational Forum

Pediatric Sepsis Guidelines: summary for resource-limited countries

Rakesh Lodha, Krishan Chugh, Soonu Udani, Suchitra Ranjit, Satish Deopujari, Rajiv Uttam, Uma Ali, Sunit Singhi, Praveen Khilnani, Indumathi Santhanam, M. Jaishree

Keywords : Pediatric, sepsis, septic shock

Citation Information : Lodha R, Chugh K, Udani S, Ranjit S, Deopujari S, Uttam R, Ali U, Singhi S, Khilnani P, Santhanam I, Jaishree M. Pediatric Sepsis Guidelines: summary for resource-limited countries. Indian J Crit Care Med 2010; 14 (1):41-52.

DOI: 10.4103/0972-5229.63029

License: CC BY-ND 3.0

Published Online: 01-01-2010

Copyright Statement:  Copyright © 2010; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Justification: Pediatric sepsis is a commonly encountered global issue. Existing guidelines for sepsis seem to be applicable to the developed countries, and only few articles are published regarding application of these guidelines in the developing countries, especially in resource-limited countries such as India and Africa. Process: An expert representative panel drawn from all over India, under aegis of Intensive Care Chapter of Indian Academy of Pediatrics (IAP) met to discuss and draw guidelines for clinical practice and feasibility of delivery of care in the early hours in pediatric patient with sepsis, keeping in view unique patient population and limited availability of equipment and resources. Discussion included issues such as sepsis definitions, rapid cardiopulmonary assessment, feasibility of early aggressive fluid therapy, inotropic support, corticosteriod therapy, early endotracheal intubation and use of positive end expiratory pressure/mechanical ventilation, initial empirical antibiotic therapy, glycemic control, and role of immunoglobulin, blood, and blood products. Objective: To achieve a reasonable evidence-based consensus on the basis of published literature and expert opinion to formulating clinical practice guidelines applicable to resource-limited countries such as India. Recommendations: Pediatric sepsis guidelines are presented in text and flow chart format keeping resource limitations in mind for countries such as India and Africa. Levels of evidence are indicated wherever applicable. It is anticipated that once the guidelines are used and outcomes data evaluated, further modifications will be necessary. It is planned to periodically review and revise these guidelines every 3-5 years as new body of evidence accumulates.


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  1. Redesigning child care: Survival, growth and development. Who health report. Geneva: WHO; 2005. p. 103-122.
  2. Khilnani P, Sarma D, Zimmerman J. Epidemiology and peculiarities of pediatric multiple organ dysfunction syndrome in New Delhi, India. Intensive Care Med 2006;32:1856-62.
  3. Brierley J, Carcillo JA, Choong K, Cornell T, Decaen A, Deymann A. et al. Practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009 Feb;37(2):666-88.
  4. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R; et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008;36:296-327.
  5. Singhi S. Pediatric Intensive Care in India: Where are we! Pediatrics Today 2007;10:230-1.
  6. Judson JA, Fisher MM. Intensive Care in Australia and New Zealand. Crit Care Clin 2006;22:407-23.
  7. Khilnani P, Chhabra R .Transport of critically ill children: How to utilize resources in the developing world. Indian J Pediatr 2008;75:591-8.
  8. Khilnani P, Sarma D, Singh R, Uttam R, Rajdev S, Makkar A, et al. Demographic profile and outcome analysis of a tertiary level pediatric intensive care unit. Indian J Pediatr 2004;71:587-91.
  9. Wills BA, Nguyen MD, Ha TL, Dong TH, Tran TN, Le TT, et al. Comparison of the three fluid solutions for resuscitation in dengue shock syndrome. N Engl J Med 2005;353:877-89.
  10. Maitland K, Pamba A, English M, Peshu N, Marsh K, Newton C, et al. Randomized trial of volume expansion with albumin or saline in children with severe malaria: Preliminary evidence of albumin benefit. Clin Infect Dis 2005;40:538-45.
  11. Scrimshaw NS, SanGiovanni JP. Synergism of nutrition, infection and immunity: An overview. Am J Clin Nutr 1997;66:464-77.
  12. Tantaleαn JA, Leσn RJ, Santos AA, Sαnchez E. Multiple organ dysfunction syndrome in children. Pediatr Crit Care Med 2003;4:181-5.
  13. World Health Organization. Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers. WHO Geneva, 1999.
  14. Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005;6:2-8.
  15. Stoll BJ, Hollman RC, Schuchat A. Decline in sepsis-associated neonatal and infant deaths in the United States, 1979 through 1994. Pediatrics 1998;102:e18.
  16. Han YY, Carcillo JA, Dragotta MA, Bills DM, Watson RS, Westerman ME, et al. Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics 2003;112:793-9.
  17. Santhanam I, Sangareddi S, Venkataraman S, Kissoon N, Thiruvengadamudayan V, Kasthuri RK. A prospective randomized control study of the two fluid regimens in the initial management of septic shock in the emergency departmant. Pediatr Emerg Care 2008;24:647-55.
  18. Upadhyay M, Singhi S, Murlidharan J, Kaur N, Majumdar S. Randomized evaluation of fluid resuscitation with crystalloid (saline) and colloid (polymer from degraded gelatin in saline) in pediatric septic shock. Indian Pediatr 2005;42:223-31.
  19. Zaritsky AL, Nadkarni VM, Hicky, RW, SchexnayderSM, Berg RA(eds Dallas. TX. Pediatric advanced life support provider manual..American heart association2002
  20. Ngo NT, Cao XT, Kneen R, Wills B, Nguyen VM, Nguyen TQ, et al. Acute management of dengue shock syndrome: A randomized double-blind comparison of 4 intravenous fluid regimens in the first hour. Clin Infect Dis 2001;32:204-13.
  21. Ranjit S, Kissoon N, Jayakumar I. Aggressive management of dengue shock syndrome may decrease mortality rate: A suggested protocol. Pediatr Crit Care Med 2005;6:412-9.
  22. Stoner MJ, Goodman DG, Cohen DM, Fernandez SA, Hall MW. Rapid fluid resuscitation in pediatrics: Testing the American College of Critical Care Medicine guideline. Ann Emerg Med 2007;50:601-7.
  23. Pollard AJ, Nadel S, Ninis N, Faust SN, Levin M. Emergency Management of Meningococcal disease: Eight years on. Arch Dis Child 2007;92:283-6.
  24. Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A, Jimenez-Jimenez FZ, Perez-Paredes C, Ortiz-Leyba C. Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 2003;31:2742-51.
  25. Wintergerst KA, Buckingham B, Gandrud L, Wong BJ, Kache S, Wilson DM. Association of hypoglycemia, hyperglycemia, and glucose variability with morbidity and death in the pediatric intensive care unit. Pediatrics 2006;118:173-9.
  26. Asghar R, Banajeh S, Egas J, Hibberd P, Iqbal I, Katep-Bwalya M, et al. Chloramphenicol versus ampicillin plus gentamicin for community acquired very severe pneumonia among children aged 2-59 months in low resource settings: Multicentre randomised controlled trial (SPEAR study). BMJ 2008;336:80-4.
  27. Osier FH, Berkley JA, Ross A, Sanderson F, Mohammed S, Newton CR. Abnormal blood glucose concentrations on admission to a rural Kenyan district hospital: Prevalence and outcome. Arch Dis Child 2003;88:621-5.
  28. Branco RG, Garcia PC, Piva JP, Casartelli CH, Seibel V, Tasker RC. Glucose level and risk of mortality in pediatric septic shock. Pediatr Crit Care Med 2005;6:470-2.
  29. Yung M, Wilkins B, Norton L, Slater A, Paediatric Study Group; Australian and New Zealand Intensive Care Society. Glucose control, organ failure, and mortality in pediatric intensive care. Pediatr Crit Care Med 2008;9:147-52.
  30. Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 2008;358:125-39.
  31. Munoz R, Khilnani P, Ziegler J, Salem M, Catlin EA, Nussbaum S, et al. Ultrafilterable hypomagnesemia in neonates admitted to the neonatal intensive care unit. Crit Care Med 1994;22:815-20.
  32. Singhi SC, Singh J, Prasad R. Hypocalcaemia in a paediatric intensive care unit. J Trop Pediatr 2003;49:298-302.
  33. Vincent JL, Bredas P, Jankowski S, Kahn RJ. Correction of hypocalcaemia in the critically ill: What is the hemodynamic benefit? Intensive Care Med 1995;21:838.
  34. Dyke PC 2nd, Yates AR, Cua CL, Hoffman TM, Hayes J, Feltes TF, et al. Increased calcium supplementation is associated with morbidity and mortality in the infant postoperative cardiac patient. Pediatr Crit Care Med 2007;8:254-7.
  35. Otieno H, Were E, Ahmed I, Charo E, Brent A, Maitland K. Are bedside features of shock reproducible between different observers? Arch Dis Child 2004;89:977-9.
  36. Ceneviva G, Paschall JA, Maffei F, Carcillo JA. Hemodynamic support in fluid-refractory pediatric septic shock. Pediatrics 1998;102:e19.
  37. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal - directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77.
  38. Padbury JF, Agata Y, Baylen BG, Ludlow JK, Polk DH, Habib DM, et al. Pharmacokinetics of dopamine in critically ill newborn infants. J Pediatr 1990;117:472-6.
  39. Sarthi M, Lodha R, Vivekanandhan S, Arora NK. Adrenal status in children with septic shock using low-dose stimulation test. Pediatr Crit Care Med 2007;8:23-8
  40. Valoor HT, Singhi S, Jayashree M. Low-dose hydrocortisone in pediatric septic shock: An exploratory study in a third world setting. Pediatr Crit Care Med 2009;10:121-5.
  41. Barton P, Garcia J, Kouatli A, Kitchen L, Zorka A, Lindsay C, et al. Hemodynamic effects of i.v. milrinone lactate in pediatric patients with septic shock. A prospective, double-blinded, randomized, placebo-controlled, interventional study. Chest 1996;109:1302-12.
  42. Vasudevan A, Lodha R, Kabra SK. Vasopressin infusion in children with catecholamine-resistant septic shock. Acta Paediatr 2005;94:380-3.
  43. Rosenzweig EB, Starc TJ, Chen JM, Cullinane S, Timchak DM, Gersony WM, et al. Intravenous arginine-vasopressin in children with vasodilatory shock after cardiac surgery. Circulation 1999;100:182-6.
  44. Lacroix J, Hιbert PC, Hutchison JS, Hume HA, Tucci M, Ducruet T, et al. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med 2007;356:1609-19.
  45. Zimmerman J. Use of blood products in sepsis: An evidence based review. Crit Care Med 2004;32:542-47.
  46. Norrby-Teglund A, Ihendyane N, Kansal R, Basma H, Kotb M, Andersson J, et al. Relative neutralizing activity in polyspecific IgM, IgA and IgG preparations against group A streptococcal superantigens. Clin Infect Dis 2000;31:1175-82.
  47. El-Nawawy A, El-Kinany H, Hamdy El-Sayed M, Boshra N. Intravenous polyclonal immunoglobulin administration to sepsis syndrome patients: A prospective study in a pediatric intensive care unit. J Trop Pediatr. 2005;51:271-8.
  48. Werdan K, Pilz G, Bujdoso O, Fraunberger P, Neeser G, Schmieder RE, et al. Score-based immunoglobulin G therapy of patients with sepsis: The SBITS study. Crit Care Med 2007;35:2693-2701.
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