Managing Pediatric Septic Shock

Those who undergo major surgical procedures or who have certain medical hardware placed, such as a central line, are at increased risk for infection and subsequent septic shock. Despite the growing knowledge of this problem, overall recognition in pediatric patients remains relatively low among physicians. To address this issue, my colleagues and I published a study in the May 16, 2011 issue ofPediatrics to describe strategies that have been effective at our institution to improve the management of pediatric septic shock. Recognizing & Treating Septic Shock Early Studies have shown that early recognition and early, aggressive, goal-directed treatment can improve clinical outcomes for children with septic shock. For each additional hour of persistent shock, the mortality risk increases twofold. It’s critical that clinicians become aware of the warning signs of pediatric septic shock. For example, they should be on the lookout for key vital signs, such as age-appropriate heart rate, respiratory rate, and blood pressure. Signs and symptoms include fever, tachycardia, tachypnea, altered mental status, and poor perfusion that may be manifested by cool skin or decreased capillary refill. Hypotension would be a late finding. Developing Protocols for Septic Shock Each hospital should develop its own systems and protocols for recognizing pediatric patients with septic shock. A key note from our study in Pediatrics was that all patients presenting to the ED who met criteria for three or more of the above symptoms or who met any one item and had low blood pressure met our protocol for septic shock. Although most patients in the protocol did not have septic shock, we wanted to cast a wide net to be able to...