Pediatric considerations.
OBJECTIVE
In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for other supportive therapies in sepsis that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and to improve outcome in severe sepsis.


METHODS
The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. Pediatric representatives attended the various section meetings and workshops to contrast adult and pediatric management. These are published here as pediatric considerations.


CONCLUSIONS
Pediatric considerations included a more likely need for intubation due to low functional residual capacity, more difficult intravenous access, fluid resuscitation based on weight with 40-60 mL kg or higher needed, decreased cardiac output and increased systemic vascular resistance as the most common hemodynamic profile, greater use of physical examination therapeutic endpoints, the unsettled issue of high-dose steroids for therapy of septic shock, and greater risk of hypoglycemia with aggressive glucose control.
Parker
Margaret M
MM
Department of Pediatrics, Stony Brook University, Stony Brook, NY, USA.
Hazelzet
Jan A
JA
Carcillo
Joseph A
JA
D002316:Cardiotonic Agents / Q000008:administration & dosage; D002648:Child; D003245:Consensus Statements as Topic; D005440:Fluid Therapy; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010437:Peptic Ulcer / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011486:Protein C / Q000627:therapeutic use; D012151:Resuscitation; D018805:Sepsis / Q000628:therapy*; D013256:Steroids / Q000627:therapeutic use; D013312:Stress, Physiological / Q000150:complications; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D020246:Venous Thrombosis / Q000517:prevention & control
D002316:Cardiotonic Agents; D011486:Protein C; D013256:Steroids; D014662:Vasoconstrictor Agents; D016178:Granulocyte-Macrophage Colony-Stimulating Factor