*in the PICU, order all antibiotics as STAT!*

*Use the PICU Sepsis Orderset for all patients in which a sepsis huddle is held and sepsis treatment is ongoig*

Sepsis

• Definition: Per the 3rd International Consensus Committee (2016) " life-threatening organ dysfunction caused by a dysregulated host response to infection."

• Complex process involving endothelial activation, microvascular compromise/thromboses, immune system activation and subsequent inflammatory response, and direct effect of virus/bacteria/fungus on host cells 

  • • •  Check out all of this and more in a review article for a review of the pathophysiology. Key infographics are below.

Pediatric Surviving Sepsis Campaign 

• Surviving Sepsis Pediatric Guidelines (2020)

  • • By Weiss et al. the most recent guidelines published on pediatrics sepsis 

• The Surviving Sepsis Website is chalk full of information/summary of guidelines for reference 

• KEY POINTS:

  • • RECOGNITION IS KEY TO SURVIVAL 

    • Early administration of antibiotics!

    • Fluid resuscitation 

    • Early vasoactive

    • Monitor end-organ function

    • Reduce metabolic demand and increase oxygen delivery (even with simple NC to increase PaO2)

Summary infomatics are below

Additional Considerations

• Obtain adequate vascular access

• Weight risks vs benefits of corticosteroids in your patients 

• Investigate source and ensure adequate source control

• May need to intubate and provide mechanical ventilation in order to reduce patient's metabolic demand during critical illness

  • • Can then further reduce metabolic demand with sedation, NMB

• Monitor end-organ function

  • • May require CRRT for acute renal failure

    • May benefit from therapeutic plasma exchange (PLEX) for replenishing ADAMS-TS 13, removing protein inhibitors in setting of TAMOF (Thrombocytopenia Associated Multiple Organ Failure)

      • • • Controversial topic, beyond scope of this website. To learn more, check out Cortina et al  and Fortenberry et al

    • May require ECMO if severe cardiac dysfunction as result of sepsis (VA-ECMO)

    • May consider immune modulation --> RBC PICU currently part of a large RCT

      • • • Examples: Il-1 inhibitors, IL-6 inhibitors, TNF-alpha inhibitors, steroids

• Future research needed surrounding unique patient's sepsis "endotype" aka what their genetic make-up is and how that primes them to respond to infection (hyperinflammatory vs immunoparalysis etc). Also great need for better biomarkers and how to stratify septic patients