Sepsis in children
Last updated: Mar 23, 2015
Management approach
Management of sepsis in children first requires prompt recognition. Attention needs to be paid to education and training of healthcare staff in the recognition of warning or adverse signs of sepsis in children and neonates to enable appropriate triage and rapid treatment. Child death reviews suggest failure to recognise severe sepsis and septic shock with delayed or inappropriate treatment at first contact with healthcare services. A standard ABC (airway, breathing, circulation) approach with particular emphasis on early administration of antibiotics and fluid resuscitation is key in the management of children with sepsis and septic shock.
Treatment according to ACCM guidelines and bundles
A care bundle is a set of protocols distilled from evidence-based practice guidelines. The aim of using a care bundle is to achieve reliability in delivering all key elements of care in a healthcare system. Compliance with guidelines or care bundles is associated with improved outcomes.
The American College of Critical Care Medicine (ACCM) published clinical practice parameters for haemodynamic support of paediatric and neonatal shock in 2002 and subsequently updated these in 2007 in the American College of Critical Care Medicine guidelines for the haemodynamic support of paediatric and neonatal septic shock (ACCM-PALS). These guidelines were drawn up by expert consensus based on extensive reviews of available literature. Following publication, several units have reported that improved survival in severe sepsis has been associated with greater compliance with ACCM-PALS guidelines. One study in the tertiary accident and emergency department at Boston Children's Hospital looked at delivery of the 5 elements of care within an hour and hospital length of stay: