Advances in the emergency management of pediatric sepsis.
OBJECTIVE
Sepsis requires prompt recognition and aggressive therapy; early goal-directed therapy decreases morbidity and mortality. Recommendations on the specific management of pediatric sepsis have historically been extrapolated from adult literature and from expert/consensus opinion. This review serves to appraise recent recommendations and determine the applicability of newly promoted adult guidelines for pediatric sepsis.


RESULTS
The first and most recent recommendations on the management of pediatric sepsis were published in 2002 by expert consensus with the recognition that there were few data from randomized controlled trials or meta-analysis. Previous to this, adult guidelines were used in the management of pediatric sepsis. New definitions for pediatric sepsis provided by expert consensus take into account the specific physiologic changes. Prompt correction of hemodynamic derangements has been shown to improve outcome through aggressive volume resuscitation and early initiation of vasopressor therapy. Frequent reassessment has been emphasized to ensure appropriate management.


CONCLUSIONS
Prompt recognition, institution of appropriate therapy, and continual assessment for children with sepsis and shock are essential for improved outcomes. The emerging new literature on early goal-directed therapy is most applicable to care in the emergency department.
Melendez
Elliot
E
Division of Emergency Medicine, Children's Hospital, Boston, Massachusetts 02115, USA. elliot.melendez@childrens.harvard.edu
Bachur
Richard
R
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D004632:Emergency Medical Services / Q000379:methods* / Q000639:trends; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D018805:Sepsis / Q000188:drug therapy / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents