[Treatment in 2003 of septic shock in children in the first two hours (excluding newborns)].
Despite new understandings in pathophysiology, sepsis mortality remains high in children. Recently, it has been demonstrated that early goal directed therapy may decrease septic shock mortality. The aim of this paper is to propose practical clinical guidelines based on earlier consensus recommendations. Septic shock must be rapidly suspected and early recognized. Bases of treatment are maintenance of adequate oxygenation with use of artificial ventilation if necessary, larger and faster volume resuscitation than recommended before, empiric antibiotherapy and early use of vasopressive agents associated with corticosteroids in particular situations. Treatment efficacy must be regularly assessed during first hours of resuscitation. Taking into account pediatric particularities and results of adult studies, pediatricians who take care of children at beginning of septic shock may reasonably hope to decrease mortality if they keep in mind specific therapeutic goals.
Service de pédiatrie-réanimation, hôpital Robert-Debré, faculté Xavier-Bichat, université Paris-VII, Paris, France. stephane.dauger@rdb.ap-hop-paris.fr
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Dauger
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Llor
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Aizenfisz
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Benayoun
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Beaufils
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods* / Q000592:standards; D004638:Emergency Treatment / Q000379:methods / Q000592:standards; D005440:Fluid Therapy / Q000379:methods / Q000592:standards; D006801:Humans; D007223:Infant; D008991:Monitoring, Physiologic / Q000379:methods / Q000592:standards; D010372:Pediatrics / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D012772:Shock, Septic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013997:Time Factors
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents