MANAGEMENT OF SEPSIS IN CHILDREN- PAEDIATRIC SEPSIS 6

Paediatric Sepsis

Reviewed Nov 2014

Due for Review Nov 2017

Issue 1 Page 1 of 5

A. INTRODUCTION

The inflammatory triad of fever, tachycardia & abnormal perfusion is very common in Children with benign infections.

Definitions (adapted from the international paediatric sepsis consensus conference definitions): 1. Infection - Proven infection by positive culture, microscopy, or PCR test caused by any pathogen OR - Clinical syndrome associated with a high probability of infection, as evidenced from clinical examination,imaging, or laboratory tests

2. Sepsis - Infection + Systemic Inflammatory Response Syndrome (tachycardia, tachypnoea, core temperature >38.5°C or <36°C, white cell count elevated or depressed for age) 3. Severe sepsis – Sepsis plus one of the following: cardiovascular dysfunction OR acute respiratory distress syndrome OR - Two or more other organ dysfunctions (respiratory, renal, neurologic, hematologic, or hepatic). 4. Septic shock - Severe Sepsis with cardiovascular dysfunction

B. THE RECOGNITION AND CLINICAL DIAGNOSIS OF SEPTIC SHOCK

• Suspected infection • Hypo or hyperthermia (temp <36℃ or >38.5℃) • Tachycardia • Tachypnoea • Altered mental status • Decreased urine output (<1 ml/kg/min) • Other end organ dysfunction • Signs of either cold or warm shock

MANAGEMENT OF SEPSIS IN CHILDREN- PAEDIATRIC SEPSIS 6

Paediatric Sepsis

Reviewed Nov 2014

Due for Review Nov 2017

Issue 1 Page 2 of 5

C. THE FIRST HOUR OF RESUSCITATION

Goals to restore:

Normal mental status Normal range heart rate for age Normal range respiratory rate for age (may not be possible if the underlying cause is pneumonia) Capillary Refill Time <3s Palpable peripheral pulses Normal range blood pressure for age. Adequate urine output Serum lactate < 2

MANAGEMENT OF SEPSIS IN CHILDREN- PAEDIATRIC SEPSIS 6

Paediatric Sepsis

Reviewed Nov 2014

Due for Review Nov 2017

Issue 1 Page 3 of 5

MANAGEMENT OF SEPSIS IN CHILDREN- PAEDIATRIC SEPSIS 6

Paediatric Sepsis

Reviewed Nov 2014

Due for Review Nov 2017

Issue 1 Page 4 of 5

MANAGEMENT OF SEPSIS IN CHILDREN- PAEDIATRIC SEPSIS 6

Paediatric Sepsis

Reviewed Nov 2014

Due for Review Nov 2017

Issue 1 Page 5 of 5

D. REFERENCES

• http://www.survivingsepsis.org/Guidelines/Documents/Pediatric%20table.pdf (The Paediatric Sepsis 6 Initiative)

• Dellinger RP, Levy MM, Rhodes A, et al: Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med.

2013; 41:580-637

• Daniels R, Nutbeam T, McNamara G, Galvin C. The Sepsis Six and the Severe Sepsis resuscitation Bundle – a prospective observational study. Emergency Medicine Journal 2011; 28(6): 507-512

• J Tong et al Arch Dis Child 2014;99: G218(P) The Paediatric Sepsis 6 Initiative

E. AUTHORS:

Dr Ashok Aralihond, Paediatric Consultant

Reviewed November 2014

Next Review November 2017