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Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine.
Crit Care Med. 2009 Feb; 37(2):666-88.CC

Abstract

BACKGROUND

The Institute of Medicine calls for the use of clinical guidelines and practice parameters to promote "best practices" and to improve patient outcomes.

OBJECTIVE

2007 update of the 2002 American College of Critical Care Medicine Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock.

PARTICIPANTS

Society of Critical Care Medicine members with special interest in neonatal and pediatric septic shock were identified from general solicitation at the Society of Critical Care Medicine Educational and Scientific Symposia (2001-2006).

METHODS

The Pubmed/MEDLINE literature database (1966-2006) was searched using the keywords and phrases: sepsis, septicemia, septic shock, endotoxemia, persistent pulmonary hypertension, nitric oxide, extracorporeal membrane oxygenation (ECMO), and American College of Critical Care Medicine guidelines. Best practice centers that reported best outcomes were identified and their practices examined as models of care. Using a modified Delphi method, 30 experts graded new literature. Over 30 additional experts then reviewed the updated recommendations. The document was subsequently modified until there was greater than 90% expert consensus.

RESULTS

The 2002 guidelines were widely disseminated, translated into Spanish and Portuguese, and incorporated into Society of Critical Care Medicine and AHA sanctioned recommendations. Centers that implemented the 2002 guidelines reported best practice outcomes (hospital mortality 1%-3% in previously healthy, and 7%-10% in chronically ill children). Early use of 2002 guidelines was associated with improved outcome in the community hospital emergency department (number needed to treat = 3.3) and tertiary pediatric intensive care setting (number needed to treat = 3.6); every hour that went by without guideline adherence was associated with a 1.4-fold increased mortality risk. The updated 2007 guidelines continue to recognize an increased likelihood that children with septic shock, compared with adults, require 1) proportionally larger quantities of fluid, 2) inotrope and vasodilator therapies, 3) hydrocortisone for absolute adrenal insufficiency, and 4) ECMO for refractory shock. The major new recommendation in the 2007 update is earlier use of inotrope support through peripheral access until central access is attained.

CONCLUSION

The 2007 update continues to emphasize early use of age-specific therapies to attain time-sensitive goals, specifically recommending 1) first hour fluid resuscitation and inotrope therapy directed to goals of threshold heart rates, normal blood pressure, and capillary refill <or=2 secs, and 2) subsequent intensive care unit hemodynamic support directed to goals of central venous oxygen saturation >70% and cardiac index 3.3-6.0 L/min/m.

Authors

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Pub Type(s)

Journal Article
Practice Guideline

Language

eng

PubMed ID

19325359

Citation

Brierley, Joe, et al. "Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock: 2007 Update From the American College of Critical Care Medicine." Critical Care Medicine, vol. 37, no. 2, 2009, pp. 666-88.
Brierley J, Carcillo JA, Choong K, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009;37(2):666-88.
Brierley, J., Carcillo, J. A., Choong, K., Cornell, T., Decaen, A., Deymann, A., Doctor, A., Davis, A., Duff, J., Dugas, M. A., Duncan, A., Evans, B., Feldman, J., Felmet, K., Fisher, G., Frankel, L., Jeffries, H., Greenwald, B., Gutierrez, J., ... Zuckerberg, A. (2009). Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Critical Care Medicine, 37(2), 666-88. https://doi.org/10.1097/CCM.0b013e31819323c6
Brierley J, et al. Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock: 2007 Update From the American College of Critical Care Medicine. Crit Care Med. 2009;37(2):666-88. PubMed PMID: 19325359.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. AU - Brierley,Joe, AU - Carcillo,Joseph A, AU - Choong,Karen, AU - Cornell,Tim, AU - Decaen,Allan, AU - Deymann,Andreas, AU - Doctor,Allan, AU - Davis,Alan, AU - Duff,John, AU - Dugas,Marc-Andre, AU - Duncan,Alan, AU - Evans,Barry, AU - Feldman,Jonathan, AU - Felmet,Kathryn, AU - Fisher,Gene, AU - Frankel,Lorry, AU - Jeffries,Howard, AU - Greenwald,Bruce, AU - Gutierrez,Juan, AU - Hall,Mark, AU - Han,Yong Y, AU - Hanson,James, AU - Hazelzet,Jan, AU - Hernan,Lynn, AU - Kiff,Jane, AU - Kissoon,Niranjan, AU - Kon,Alexander, AU - Irazuzta,Jose, AU - Irazusta,Jose, AU - Lin,John, AU - Lorts,Angie, AU - Mariscalco,Michelle, AU - Mehta,Renuka, AU - Nadel,Simon, AU - Nguyen,Trung, AU - Nicholson,Carol, AU - Peters,Mark, AU - Okhuysen-Cawley,Regina, AU - Poulton,Tom, AU - Relves,Monica, AU - Rodriguez,Agustin, AU - Rozenfeld,Ranna, AU - Schnitzler,Eduardo, AU - Shanley,Tom, AU - Kache,Saraswati, AU - Skache,Sara, AU - Skippen,Peter, AU - Torres,Adalberto, AU - von Dessauer,Bettina, AU - Weingarten,Jacki, AU - Yeh,Timothy, AU - Zaritsky,Arno, AU - Stojadinovic,Bonnie, AU - Zimmerman,Jerry, AU - Zuckerberg,Aaron, PY - 2009/3/28/entrez PY - 2009/3/28/pubmed PY - 2009/5/7/medline SP - 666 EP - 88 JF - Critical care medicine JO - Crit Care Med VL - 37 IS - 2 N2 - BACKGROUND: The Institute of Medicine calls for the use of clinical guidelines and practice parameters to promote "best practices" and to improve patient outcomes. OBJECTIVE: 2007 update of the 2002 American College of Critical Care Medicine Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock. PARTICIPANTS: Society of Critical Care Medicine members with special interest in neonatal and pediatric septic shock were identified from general solicitation at the Society of Critical Care Medicine Educational and Scientific Symposia (2001-2006). METHODS: The Pubmed/MEDLINE literature database (1966-2006) was searched using the keywords and phrases: sepsis, septicemia, septic shock, endotoxemia, persistent pulmonary hypertension, nitric oxide, extracorporeal membrane oxygenation (ECMO), and American College of Critical Care Medicine guidelines. Best practice centers that reported best outcomes were identified and their practices examined as models of care. Using a modified Delphi method, 30 experts graded new literature. Over 30 additional experts then reviewed the updated recommendations. The document was subsequently modified until there was greater than 90% expert consensus. RESULTS: The 2002 guidelines were widely disseminated, translated into Spanish and Portuguese, and incorporated into Society of Critical Care Medicine and AHA sanctioned recommendations. Centers that implemented the 2002 guidelines reported best practice outcomes (hospital mortality 1%-3% in previously healthy, and 7%-10% in chronically ill children). Early use of 2002 guidelines was associated with improved outcome in the community hospital emergency department (number needed to treat = 3.3) and tertiary pediatric intensive care setting (number needed to treat = 3.6); every hour that went by without guideline adherence was associated with a 1.4-fold increased mortality risk. The updated 2007 guidelines continue to recognize an increased likelihood that children with septic shock, compared with adults, require 1) proportionally larger quantities of fluid, 2) inotrope and vasodilator therapies, 3) hydrocortisone for absolute adrenal insufficiency, and 4) ECMO for refractory shock. The major new recommendation in the 2007 update is earlier use of inotrope support through peripheral access until central access is attained. CONCLUSION: The 2007 update continues to emphasize early use of age-specific therapies to attain time-sensitive goals, specifically recommending 1) first hour fluid resuscitation and inotrope therapy directed to goals of threshold heart rates, normal blood pressure, and capillary refill <or=2 secs, and 2) subsequent intensive care unit hemodynamic support directed to goals of central venous oxygen saturation >70% and cardiac index 3.3-6.0 L/min/m. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/19325359/Clinical_practice_parameters_for_hemodynamic_support_of_pediatric_and_neonatal_septic_shock:_2007_update_from_the_American_College_of_Critical_Care_Medicine_ L2 - https://dx.doi.org/10.1097/CCM.0b013e31819323c6 DB - PRIME DP - Unbound Medicine ER -