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Sepsis current pediatric guidelines

Amanda B Hassinger, Sudha Garimella, Brian H Wrotniak, Jo L Freudenheim
OBJECTIVES: Increasingly prevalent in pediatric intensive care, acute kidney injury imparts significant short- and long-term consequences. Despite advances in acute kidney injury research, clinical outcomes are worsening. We surveyed pediatric critical care physicians to describe the current state of acute kidney injury diagnosis and management in critically ill children. DESIGN: Anonymous electronic questionnaire. PARTICIPANTS: Pediatric critical care physicians from academic centers, the Pediatric Acute Lung Injury and Sepsis Investigators network, and/or the pediatric branch of Society of Critical Care Medicine...
August 2016: Pediatric Critical Care Medicine
Brittany Mathias, Juan C Mira, Shawn D Larson
PURPOSE OF REVIEW: Sepsis is the leading cause of pediatric death worldwide. In the United States alone, there are 72 000 children hospitalized for sepsis annually with a reported mortality rate of 25% and an economic cost estimated to be $4.8 billion. However, it is only recently that the definition and management of pediatric sepsis has been recognized as being distinct from adult sepsis. RECENT FINDINGS: The definition of pediatric sepsis is currently in a state of evolution, and there is a large disconnect between the clinical and research definitions of sepsis which impacts the application of research findings into clinical practice...
June 2016: Current Opinion in Pediatrics
Amanda Carmean, James D Fortenberry, Courtney McCracken, Kiran B Hebbar
OBJECTIVE: Although corticosteroid (CS) supplementation for pediatric septic shock (PSS) is recommended by American College of Critical Care Medicine sepsis guidelines, most data are based on adult trials. Standardized protocols for stimulation testing for adrenal insufficiency (AI) and CS treatment in children have been reported, but the current state of CS use and protocols have not been evaluated in pediatric intensive care units in the United States. We surveyed a group of pediatric intensivists to assess current approaches...
October 2015: Pediatric Emergency Care
Graham C Thompson, Charles G Macias
BACKGROUND: Pediatric sepsis remains a leading cause of morbidity and mortality. Understanding current practice patterns and challenges is essential to inform future research and education strategies. OBJECTIVE: Our aim was to describe the practice patterns of pediatric emergency physicians (PEPs) in the recognition and management of sepsis in children and to identify perceived priorities for future research and education. METHODS: We conducted a cross-sectional, internet-based survey of members of the American Academy of Pediatrics, Section on Emergency Medicine and Pediatric Emergency Research Canada...
October 2015: Journal of Emergency Medicine
Jeffrey D Edwards, Carolyn T Herzig, Hangsheng Liu, Monika Pogorzelska-Maziarz, Philip Zachariah, Andrew W Dick, Lisa Saiman, Patricia W Stone, E Yoko Furuya
BACKGROUND: Knowing the temporal trend central line-associated bloodstream infection (CLABSI) rates among U.S. pediatric intensive care units (PICUs), the current extent of central line bundle compliance, and the impact of compliance on rates is necessary to understand what has been accomplished and can be improved in CLABSI prevention. METHODS: This is a longitudinal study of PICUs in National Healthcare Safety Network hospitals and a cross-sectional survey of directors and managers of infection prevention and control departments regarding PICU CLABSI prevention practices, including self-reported compliance with elements of central line bundles...
May 1, 2015: American Journal of Infection Control
N Rabirad, M Mohammadpoor, A Rastegar Lari, A Shojaie, R Bayat, M Alebouyeh
INTRODUCTION: The choice of antimicrobial treatment for septicemia is often empirical and based on the knowledge of local anti-microbial activity patterns of the most common bacteria causing such bloodstream infections. The current study aimed to study the prevalence of bacterial pathogens causing septicemia and their antimicrobial resistant profiles in hospital admitted patients. METHODS: This cross sectional study done at Children's Medical Center, Tehran, Iran...
March 2014: Journal of Preventive Medicine and Hygiene
L Koch, A Bosk, M Sasse, P Ruef, J Poeschl
BACKGROUND: In 2002 and 2007, the American College of Critical Care Medicine (ACCCM) provided clinical guidelines for hemodynamic support of pediatric and neonatal patients in septic shock. In 2008 and 2013, the Surviving Sepsis Campaign (SSC) Guidelines Committee offered up-to-date clinical guidelines for the management of severe sepsis and septic shock in adults and in pediatric patients. The aim of this study was to assess the standard of care of neonates with severe sepsis and septic shock in German neonatal intensive care units (NICUs) with regard to variability in management and guideline conformity...
January 2015: Klinische Pädiatrie
E A H Loeffen, R L Mulder, L C M Kremer, E M C Michiels, F C H Abbink, L M Ball, H Segers, A M C Mavinkurve-Groothuis, F J Smit, I J M Vonk, M D Vd Wetering, W J E Tissing
INTRODUCTION: Currently, very few guidelines for supportive care for children with cancer exist. In the Netherlands, nationwide guidelines are over 10 years old and mostly based on expert opinion. Consequently, there is growing support and need for clinical practice guidelines (CPGs), which ought to be developed with a well-defined methodology and include a systematic search of literature, evidence summaries, and a transparent description of the decision process for the final recommendations...
July 2015: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Nchafatso Obonyo, Kathryn Maitland
Management of shock in children with severe malnutrition remains controversial. To date, the evidence supporting either benefit or harm of fluid resuscitation or rehydration is weak. This issue, however, is not unique to children with severe malnutrition; pediatric guidelines worldwide have a weak level of evidence and remain unsupported by appropriate clinical studies. In this review we give an overview of the current recommendations in other pediatric populations and appraise the strength of evidence supporting these...
June 2014: Food and Nutrition Bulletin
Natalie Jayaram, John A Spertus, Vinay Nadkarni, Robert A Berg, Fengming Tang, Tia Raymond, Anne-Marie Guerguerian, Paul S Chan
BACKGROUND: Although survival after in-hospital cardiac arrest is likely to vary among hospitals caring for children,validated methods to risk-standardize pediatric survival rates across sites do not currently exist. METHODS AND RESULTS: From 2006 to 2010, within the American Heart Association's Get With the Guidelines-Resuscitation registry for in-hospital cardiac arrest, we identified 1551 cardiac arrests in children (<18 years). Using multivariable hierarchical logistic regression, we developed and validated a model to predict survival to hospital discharge and calculated risk-standardized rates of cardiac arrest survival for hospitals with a minimum of 10 pediatric cardiac arrest cases...
July 2014: Circulation. Cardiovascular Quality and Outcomes
Laura Santos
Sepsis brings about neuroendocrine dysfunction in children that differs significantly from that of adults and can thus be difficult to interpret and manage. Aggressive treatment of sepsis with appropriate and judicious use of antibiotics remains a top priority. Strict glycemic control in children has been associated with significant risk of hypoglycemia, which may independently contribute to morbidity and mortality. Timely initiation of hydrocortisone in persistently hypotensive children with fluid-refractory, catecholamine-resistant shock is controversial, but its use in children with suspected or proven adrenal insufficiency is suggested...
November 2013: Current Problems in Pediatric and Adolescent Health Care
J Prunier-Duparge, A Desrumaux, T Debillon, C Bost-Bru, C Jannel, A Gayot, I Wroblewski
Mycoplasma pneumonia is responsible for multisystemic infection. Pulmonary symptoms are most common in children. We describe herein two unusual severe forms of M. pneumoniae infection without initial pulmonary symptoms. The first case is an 8-month-old boy who was hospitalized in the pediatric intensive care unit with severe sepsis. There were no initial pulmonary symptoms, nor obvious clinical infection. Initial blood tests and x-ray did not aid the diagnosis. The blood tests came back positive for M. pneumonia...
October 2013: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Elizabeth J Winokur, Debra Pai, Dana N Rutledge, Kate Vogel, Sadeeka Al-Majid, Christine Marshall, Paul Sheikewitz
INTRODUCTION: Lack of specific guidelines regarding collection of blood for culture from central venous catheters (CVCs) has led to inconsistencies in policies among hospitals. Currently, no specific professional or regulatory recommendations exist in relation to using, reinfusing, or discarding blood drawn from CVCs before drawing blood for a culture. Repeated wasting of blood may harm immunocompromised pediatric oncology patients. The purpose of this comparative study was to determine whether differences exist between blood cultures obtained from the first 5 mL of blood drawn from a CVC line when compared with the second 5 mL drawn...
July 2014: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
Vidyut Bhatia, Ashish Bavdekar, Surender Kumar Yachha
PROCESS: Selected members were requested to prepare guidelines on specific issues, which were reviewed by two other members. These guidelines were then incorporated into a draft statement, which was circulated to all members. On 17th December 2011, Kunwar Viren Oswal round table conference was organized by the Apollo Center for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi and the Sub-specialty Chapter of Pediatric Gastroenterology, Indian Academy of Pediatrics. Presentations, ensuing discussions, and opinions expressed by the participants were incorporated into the final draft...
May 8, 2013: Indian Pediatrics
Miriam Santschi, Francis Leclerc
BACKGROUND: Pediatric sepsis represents an important cause of mortality in pediatric intensive care units (PICU). Although adherence to published guidelines for the management of severe sepsis patients is known to lower mortality, actual adherence to these recommendations is low. The aim of this study was to describe the initial management of pediatric patients with severe sepsis, as well as to describe the main barriers to the adherence to current guidelines on management of these patients...
2013: Annals of Intensive Care
Marroyln L Simmons, Spencer H Durham, Chenita W Carter
With an overall mortality rate of 4.2%, sepsis is one of the most common causes of death in children worldwide. The Surviving Sepsis Campaign outlines rapid initiation of volume resuscitation with crystalloids and timely administration of broad-spectrum antibiotics as the backbone of sepsis treatment. Initial antibiotics should be broad enough to cover the most likely pathogens, but antibiotic therapy should be de-escalated when culture results become available. Therapy with a vasopressor and/or an inotrope is often necessary in patients with sepsis to improve blood pressure and cardiac output...
October 2012: AACN Advanced Critical Care
Joseph M Larochelle, Jill A Morgan, Kristine A Parbuoni
BACKGROUND: The 2008 Surviving Sepsis Campaign guidelines state that intravenous antibiotic therapy should be started within the first hour of recognition of septic shock. Currently, there are no published studies looking at antibiotic timing in pediatric sepsis patients. OBJECTIVES: The purpose of this study is to determine if sepsis patients admitted to a Pediatric Intensive Care Unit (PICU) are administered antibiotics in the appropriate time frame according to the Surviving Sepsis Guidelines...
October 2009: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
John G T Augoustides
Steroids and statins may facilitate the integration of anesthetic design with clinical outcome. Although steroids clearly benefit adult cardiac surgical patents, the evidence is weaker in pediatric cardiac surgery. Current large randomized trials of steroids likely will determine the future role of steroids in adult cardiac surgery. In the intensive care unit, steroid therapy is indicated in septic shock that is refractory to fluid and pressor therapy. Recent data, however, indicate that liberal steroid therapy for sepsis may have adverse outcome consequences...
October 2011: Journal of Cardiothoracic and Vascular Anesthesia
Hamilton P Schwartz, Beth E Haberman, Richard M Ruddy
It is estimated that about two thirds of newborns will appear clinically jaundiced during their first weeks of life. As newborns and their mothers spend fewer days in the hospital after birth, the number of infants readmitted yearly in the United States for neonatal jaundice over the last 10 years has increased by 160%. A portion of these infants present to the emergency department, requiring a careful history and physical examination assessing them for the risk factors associated with pathologic bilirubin levels...
September 2011: Pediatric Emergency Care
Scott T Benken, Tamara K Hutson, Rhonda L Gardiner, Derek S Wheeler
Recently published consensus treatment guidelines for pediatric sepsis recommend initiating corticosteroid replacement therapy (CRT) for those critically ill children with adrenal insufficiency and refractory shock. The data to support this recommendation is limited, and multiple studies have demonstrated significant variation in both the diagnosis and treatment of adrenal insufficiency and refractory shock in children. In order to better define the variation in practice at our institution, we retrospectively reviewed the experience with CRT in critically ill children with refractory septic shock over a 1-year-period...
January 1, 2010: Open Critical Care Medicine Journal
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