• Paediatric sepsis
    Link:www.sort.nhs.uk/Media/Guidelines/Guidelinesfortheretrievalandmanagementofseveresepsisandsepticshockininfantsandchildren.pdf
    • Pathophysiology
      • Dependent on age
      • Commonest cause of death in children is cardiac failure but in adults is vasomotor paralysis
      • In adults, myocardial dysfunction results in reduced EF but co is maintained by tachycardia
      • In paeds, septic shock is associated with profound by hypovolaemia and fluid resuscitation is helpful. Reduced cardiac output rather than systemic vascular resistance is associated with mortality in paediatric septic shock
      • Oxygen delivery in children, rather than extraction, is the major determinant of consumption so achieving a goal of 200ml/min/m² may improve outcome
    • Maintain airway, give 100% O₂, establish IV/IO access, give antibiotics
    • Principles of management
      • May be recognised before hypotension due to hyper/hypo-thermia, cool peripheries (cold shock), warm peripheries (warm shock) or altered mental status
      • Aggressive resuscitation and goal directed therapy should be used
      • Rapid fluid resuscitation is associated with improved survival
      • 5% albumin may be used as the fluid of choice
    • Adjuvant treatments
      • Protein C
      • Insulin
        • Aim to keep glucose 4.4-6.1
        • Unknown if this helps in paediatrics
        • Tight control is associated with more hypoglycaemic episodes
      • Steroids
        • Poor evidence but sometimes used
      • IV immunoglobulin
      • Blood purification techniques
        • Uncertain benefit
    • Ventilation
      • ARDS protocols are used
      • Low Vt 6-7ml/kg
      • Peep of 8-9cm water
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/4/1/12.full.pdf?sid=aba81ea3-6057-4d64-a853-5869ffa52b44
    • Paediatric infusions
      Link:www.strs.nhs.uk/resources/pdf/guidelines/druginfusion.pdf
    • 20ml/kg bolus of colloid
      Correct hypoglycaemia
      • Elective trachea intubation if >60ml/kg required
        CVC access
        Start dopamine infusion
        Maintain Hb at >10
        • Titrate adrenaline for cold shock
          Titrate norad for warm shock
          Consider hydrocortisone
          • Cold shock low BP
            Titrate volume and adrenaline
            • Refractory shock
              Monitor c.o.
              Maintain CI 3.3-6L/min/m²
              Target O₂ consumption >200 ml/min/m²
          • Warm shock low BP
            Titrate volume and norad
            Consider vasopressin
          • Cold shock N BP
            Consider milrinone or enoximone plus volume