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VOLUME 9 , ISSUE 3 ( July, 2005 ) > List of Articles


Clinical management guidelines of pediatric septic shock

Praveen Khilnani

Keywords : Pediatric, sepsis, septic shock, critically ill, management guidelines

Citation Information : Khilnani P. Clinical management guidelines of pediatric septic shock. Indian J Crit Care Med 2005; 9 (3):164-172.

DOI: 10.4103/0972-5229.19683

License: CC BY-ND 3.0

Published Online: 01-01-2010

Copyright Statement:  Copyright © 2005; The Author(s).


Septic shock in children is the prototype combination of hypovolemia, cardiogenic and distributive shock. Recently published American college of critical care medinie (ACCM) recommendations for hemodynamic support of neonatal and pediatric patients with sepsis, Surviving sepsis campaign and its pediatric considerations and subsequent revision of definitions for pediatric sepsis has led to compilation of this review article. Practical application of this information in Indian set up in a child with septic shock will be discussed based on available evidence. Though guidelines mainly apply to pediatric age group, however a reference has been made to neonatal age group wherever applicable.

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  1. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32:858-73.
  2. Parker MM, Hazelzet JA, Carcillo JA. Pediatric considerations. Crit Care Med 2004;32:591-4.
  3. Carcillo JA, Fields AI. Task Force Committee members: clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 2002;30:1365-78.
  4. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992;101:1644-55.
  5. Goldstein B, Giroir B, Randolph A, et al. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005;6:2-8.
  6. Griffel MI, Kaufman BS. Pharmacology of colloids and crystalloids. Critical Care Clinics 1992;8: 235-53.
  7. Ranjit S, Kisson N, Jayakumar I. Aggressive management of dengue shock syndrome may decrease mortality rate: a suggested protocol. Pediatr Crit Care Med 2005;6:412-9
  8. 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.
  9. Ceneviva G, Paschall JA, Maffei F, Carcillo JA. Hemodynamic support in fluid-refractory pediatric septic shock. Pediatrics 1998;102:e19.
  10. Barton P, Garcia J, Kouatli A, 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
  11. Lindsay CA, Barton P, Lawless S, et al. Pharmacokinetics and pharmacodynamics of milrinone lactate in pediatric patients with septic shock. J Pediatr 1998;132:329-34.
  12. Irazuzta JE, Pretzlaff RK, Rowin ME. Amrinone in pediatric refractory septic shock: an open-label pharmacodynamic study. Pediatr Crit Care Med 2001;2:24-8
  13. Pollard AJ, Britto J, Nadel S, DeMunter C, Habibi P, Levin M. Emergency management of meningococcal disease. Arch Dis Child 1999;80:290-6.
  14. Kanter RK, Zimmerman JJ, Strauss RH, Stoeckel KA. Pediatric emergency intravenous access: evaluation of a protocol. Am J Dis Child 1986;140:132-4
  15. Carcillo JA, Davis AL, Zaritsky A. Role of early fluid resuscitation in pediatric septic shock. JAMA 1991;266:1242-5.
  16. Powell KR, Sugarman LI, Eskenazi AE, Woodin KA, Kays MA, McCormick KL, et al. Normalization of plasma arginine vasopressin concentrations when children with meningitis are given maintenance plus replacement fluid therapy. J Pediatr 1991;117:515-22.
  17. Keeley SR, Bohn DJ. The use of inotropic and afterload-reducing agents in neonates. Clin Perinatol 1988;15:467-89.
  18. Roberts JD, Jr, Fineman JR, Morin FC, III. Inhaled nitric oxide and persistent pulmonary hypertension of the new born. N Engl J Med 1997;336:605-10.
  19. 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.
  20. De Kleijn ED, Joosten KF, Van Rijn B, Westerterp M, De Groot R, Hokken-Koelega AC, et al. Low serum cortisol in combination with high adrenocorticotrophic hormone concentrations are associated with poor outcome in children with severe meningococcal disease. Pediatr Infect Dis J 2002;21:330-6.
  21. Riordan FA, Thomson AP, Ratcliffe JM, Sills JA, Diver MJ, Hart CA. Admission cortisol and adrenocorticotrophic hormone levels in children with meningococcal disease: evidence of adrenal insufficiency? Crit Care Med 1999;27:2257-61.
  22. Min M, U T, Aye M, Shwe TN, Swe T. Hydrocortisone in the management of dengue shock syndrome. Southeast Asian J Trop Med Public Health 1975;6:573-9.
  23. Sumarmo, Talogo W, Asrin A, Isnuhandojo B, Sahudi A. Failure of hydrocortisone to affect outcome in dengue shock syndrome. Pediatrics 1982;69:45-9.
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