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Crit Care Med. 2017 Jun;45(6):1061-1093. doi: 10.1097/CCM.0000000000002425.

American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock.

Author information

1
1No institution affiliation. 2Department of Critical Care Medicine and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA. 3Department of Pediatric Critical Care, Riley Hospital for Children, Indiana University, IN. 4Department of Pediatrics, Washington University School of Medicine, St. Louis, MO. 5Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX. 6Pediatric Critical Care Medicine, Covenant Women and Children's Hospital, Texas Tech University, Lubbock, TX. 7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL. 8Division of Pediatric Critical Care, University of British Columbia, Vancouver, BC, Canada. 9Division of Pediatric Critical Care Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI. 10Department of Pediatrics, Baylor College of Medicine, Houston, TX. 11Department of Pediatrics, Saint Barnabas Medical Center, Livingston, NJ. 12Division of Emergency Medicine and Center for Pediatric Clinical Effectiveness, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA. 13Intensive Care & Bioethics, Great Ormond St Hospital for Sick Children, London, United Kingdom. 14Pediatric Critical Care Medicine, Department of Pediatrics, Stollery Children's Hospital/University of Alberta, Edmonton, AB, Canada. 15Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's, Durham, NC. 16Departments of Pediatrics and Critical Care, Clinical Epidemiology and Biostatistics, McMaster University, Pediatric Intensive Care Unit, McMaster Children's Hospital, Hamilton, ON, Canada. 17Beth Israel Medical Center, Hartsdale, NY. 18Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI. 19Departments of Pediatrics and Biochemistry, Washington University in Saint Louis School of Medicine, Saint Louis, MO. 20Department of Pediatrics, Centre mère-enfant Soleil du CHU de Québec-Université Laval, Québec City, QC, Canada. 21Department of Inpatient Pediatrics, Kaiser Santa Clara Medical Center, Santa Clara, CA. 22Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA. 23Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Mott C.S. Children's Hospital, Ann Arbor, MI. 24Division of Critical Care, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. 25Department of Pediatrics-Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD. 26Division of Pediatric Critical Care Medicine, Weill Cornell Medical College, New York, NY. 27Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH. 28Department of Critical Care Medicine, Children's Mercy Hospital, Kansas City, MO. 29Department of Pediatrics, Texas Tech University Health Sciences Center, El Paso, TX. 30Division of Pediatric Critical Care, University of Florida, Jacksonville, FL. 31Bon Secours St. Mary's Hospital, Glen Allen, VA. 32Division of Pediatric Critical Care, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY. 33Department of Pediatrics, University of Washington School of Medicine, Seattle, WA. 34Division of Critical Care, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA. 35Pediatric Critical Care Medicine, The Children's Hospital at Montefiore, The Pediatric Hospital for Albert Einstein College of Medicine, Bronx, NY. 36Department of Pediatrics, University of British Columbia, UBC & BC Children's Hospital Professor in Critical Care-Global Child Health, Vancouver, BC, Canada. 37Department of Pediatrics, Naval Medical Center San Diego and University of California San Diego School of Medicine, San Diego, CA. 38Department of Pediatrics and Pediatric Critical Care Medicine, The Valley Hospital, Ridgewood, NJ. 39Cardiothoracic ICU, National University Hospital, Singapore. 40Paediatric ICU, The Royal Children's Hospital, Melbourne, Australia. 41Department of Paediatrics, University of Melbourne, Melbourne, Australia. 42Children's Hospital of Pittsburgh, Pittsburgh, PA. 43Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, GA. 44Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI. 45Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA. 46Division of Emergency Medicine, Ann and Robert Lurie Children's Hospital of Chicago, Feinberg School of Medicine at Northwestern University, Chicago, IL. 47UCL Great Ormond Street Institute of Child Health and Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom. 48Pediatric Intensive Care and Emergency Services, Apollo Children's Hospital, Chennai, India. 49Division of Pediatric Critical Care, Department of Pediatrics, Duke University School of Nursing and School of Medicine, Durham, NC. 50Pediatrics School of Medicine, Austral University, Pcia de Buenos Aires, Argentina. 51Departments of Pediatrics and Emergency Medicine, University of Colorado School of Medicine, Aurora, CO. 52Critical Care and Transport, Nemours Children's Hospital, Orlando, FL. 53Department of Pediatrics, Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY. 54Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA. 55Departments of Pediatrics & Anesthesiology, Sinai Hospital/NAPA, Baltimore, MD. 56Department of Pediatrics, University of Maryland Medical School, Baltimore, MD.

Abstract

OBJECTIVES:

The American College of Critical Care Medicine provided 2002 and 2007 guidelines for hemodynamic support of newborn and pediatric septic shock. Provide the 2014 update of the 2007 American College of Critical Care Medicine "Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock."

DESIGN:

Society of Critical Care Medicine members were identified from general solicitation at Society of Critical Care Medicine Educational and Scientific Symposia (2006-2014). The PubMed/Medline/Embase literature (2006-14) was searched by the Society of Critical Care Medicine librarian using the keywords: sepsis, septicemia, septic shock, endotoxemia, persistent pulmonary hypertension, nitric oxide, extracorporeal membrane oxygenation, and American College of Critical Care Medicine guidelines in the newborn and pediatric age groups.

MEASUREMENTS AND MAIN RESULTS:

The 2002 and 2007 guidelines were widely disseminated, translated into Spanish and Portuguese, and incorporated into Society of Critical Care Medicine and American Heart Association/Pediatric Advanced Life Support sanctioned recommendations. The review of new literature highlights two tertiary pediatric centers that implemented quality improvement initiatives to improve early septic shock recognition and first-hour compliance to these guidelines. Improved compliance reduced hospital mortality from 4% to 2%. Analysis of Global Sepsis Initiative data in resource rich developed and developing nations further showed improved hospital mortality with compliance to first-hour and stabilization guideline recommendations.

CONCLUSIONS:

The major new recommendation in the 2014 update is consideration of institution-specific use of 1) a "recognition bundle" containing a trigger tool for rapid identification of patients with septic shock, 2) a "resuscitation and stabilization bundle" to help adherence to best practice principles, and 3) a "performance bundle" to identify and overcome perceived barriers to the pursuit of best practice principles.

PMID:
28509730
DOI:
10.1097/CCM.0000000000002425
[Indexed for MEDLINE]

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