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Treatment of Pediatric Septic Shock With the Surviving Sepsis Campaign Guidelines and PICU Patient Outcomes.
Pediatr Crit Care Med. 2016 10; 17(10):e451-e458.PC

Abstract

OBJECTIVES

The Surviving Sepsis Campaign recommends rapid recognition and treatment of severe sepsis and septic shock. Few reports have evaluated the impact of these recommendations in pediatrics. We sought to determine if outcomes in patients who received initial care compliant with the Surviving Sepsis Campaign time goals differed from those treated more slowly.

DESIGN

Single center retrospective cohort study.

SETTING

Emergency department and PICU at an academic children's hospital.

PATIENTS

Three hundred twenty-one patients treated for septic shock in the emergency department and admitted directly to the PICU.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The exposure was receipt of emergency department care compliant with the Surviving Sepsis Campaign recommendations (delivery of IV fluids, IV antibiotics, and vasoactive infusions within 1 hr of shock recognition). The primary outcome was development of new or progressive multiple organ dysfunction syndrome. Secondary outcomes included mortality, need for mechanical ventilation or vasoactive medications, and hospital and PICU length of stay. Of the 321 children studied, 117 received Surviving Sepsis Campaign compliant care in the emergency department and 204 did not. New or progressive multiple organ dysfunction syndrome developed in nine of the patients (7.7%) who received Surviving Sepsis Campaign compliant care and 25 (12.3%) who did not (p = 0.26). There were 17 deaths; overall mortality rate was 5%. There were no significant differences between groups in any of the secondary outcomes. Although only 36% of patients met the Surviving Sepsis Campaign guideline recommendation of bundled care within 1 hour of shock recognition, 75% of patients received the recommended interventions in less than 3 hours.

CONCLUSIONS

Treatment for pediatric septic shock in compliance with the Surviving Sepsis Campaign recommendations was not associated with better outcomes compared with children whose initial therapies in the emergency department were administered more slowly. However, all patients were treated rapidly and we report low morbidity and mortality. This underscores the importance of rapid recognition and treatment of septic shock.

Authors+Show Affiliations

1Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT.2Department of Mathematics, University of Utah, Salt Lake City, UT.3Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, UT.4Department of System Improvement, Primary Children's Hospital, Salt Lake City, UT.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27500722

Citation

Workman, Jennifer K., et al. "Treatment of Pediatric Septic Shock With the Surviving Sepsis Campaign Guidelines and PICU Patient Outcomes." Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 17, no. 10, 2016, pp. e451-e458.
Workman JK, Ames SG, Reeder RW, et al. Treatment of Pediatric Septic Shock With the Surviving Sepsis Campaign Guidelines and PICU Patient Outcomes. Pediatr Crit Care Med. 2016;17(10):e451-e458.
Workman, J. K., Ames, S. G., Reeder, R. W., Korgenski, E. K., Masotti, S. M., Bratton, S. L., & Larsen, G. Y. (2016). Treatment of Pediatric Septic Shock With the Surviving Sepsis Campaign Guidelines and PICU Patient Outcomes. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 17(10), e451-e458.
Workman JK, et al. Treatment of Pediatric Septic Shock With the Surviving Sepsis Campaign Guidelines and PICU Patient Outcomes. Pediatr Crit Care Med. 2016;17(10):e451-e458. PubMed PMID: 27500722.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of Pediatric Septic Shock With the Surviving Sepsis Campaign Guidelines and PICU Patient Outcomes. AU - Workman,Jennifer K, AU - Ames,Stefanie G, AU - Reeder,Ron W, AU - Korgenski,E Kent, AU - Masotti,Susan M, AU - Bratton,Susan L, AU - Larsen,Gitte Y, PY - 2016/8/9/pubmed PY - 2017/10/13/medline PY - 2016/8/9/entrez SP - e451 EP - e458 JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JO - Pediatr Crit Care Med VL - 17 IS - 10 N2 - OBJECTIVES: The Surviving Sepsis Campaign recommends rapid recognition and treatment of severe sepsis and septic shock. Few reports have evaluated the impact of these recommendations in pediatrics. We sought to determine if outcomes in patients who received initial care compliant with the Surviving Sepsis Campaign time goals differed from those treated more slowly. DESIGN: Single center retrospective cohort study. SETTING: Emergency department and PICU at an academic children's hospital. PATIENTS: Three hundred twenty-one patients treated for septic shock in the emergency department and admitted directly to the PICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The exposure was receipt of emergency department care compliant with the Surviving Sepsis Campaign recommendations (delivery of IV fluids, IV antibiotics, and vasoactive infusions within 1 hr of shock recognition). The primary outcome was development of new or progressive multiple organ dysfunction syndrome. Secondary outcomes included mortality, need for mechanical ventilation or vasoactive medications, and hospital and PICU length of stay. Of the 321 children studied, 117 received Surviving Sepsis Campaign compliant care in the emergency department and 204 did not. New or progressive multiple organ dysfunction syndrome developed in nine of the patients (7.7%) who received Surviving Sepsis Campaign compliant care and 25 (12.3%) who did not (p = 0.26). There were 17 deaths; overall mortality rate was 5%. There were no significant differences between groups in any of the secondary outcomes. Although only 36% of patients met the Surviving Sepsis Campaign guideline recommendation of bundled care within 1 hour of shock recognition, 75% of patients received the recommended interventions in less than 3 hours. CONCLUSIONS: Treatment for pediatric septic shock in compliance with the Surviving Sepsis Campaign recommendations was not associated with better outcomes compared with children whose initial therapies in the emergency department were administered more slowly. However, all patients were treated rapidly and we report low morbidity and mortality. This underscores the importance of rapid recognition and treatment of septic shock. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/27500722/Treatment_of_Pediatric_Septic_Shock_With_the_Surviving_Sepsis_Campaign_Guidelines_and_PICU_Patient_Outcomes_ L2 - https://doi.org/10.1097/PCC.0000000000000906 DB - PRIME DP - Unbound Medicine ER -