title: Paediatric Septic Shock tags: #FFICM #Paediatrics #Sepsis notebook: 🌑-FFICM
source: eLfH category: paediatrics
Paediatric Septic Shock
The key differences are that infants and younger children have different targets needed than adults, but that they can also recover in situations where adults wouldn't. 1
Defns
In children with infection fever, tachycardia, and vasodilatation are common. When combined with change in mental status shock should be considered. 1
Normal HR + Sys BP + Perfusion Pressure Ranges by Age: 1
| Age | HR | Sys BP | Perfusion Pressure |
|---|---|---|---|
| <1 | 110 - 160 | 70-90 | 60 |
| 2-5 | 95-140 | 80-100 | 65 |
| 5-12 | 80-120 | 90-110 | 65 |
| 12+ | 60-100 | 100-120 | 65 |
Normal RR Ranges by Age: 1
| Age | RR |
|---|---|
| <1 | 30-40 |
| 1-2 | 26-34 |
| 2-5 | 24-30 |
| 5-12 | 20-24 |
| 12+ | 12-20 |
Predisposition/Age
Neonatal Sepsis incidence is 4.3/1000 1
Neonatal Sepsis Mortality is 20% 1
Older Children Sepsis Mortality is around 10% 1
Children with predisposing factors (chemo, tubes, lines, ICU stays) are more likely to get nosocomial infections 1
Organisms
Less Than 3 Months
- Group B Strep
- Enterococcus
- Listeria
- Pseudomonas
- E. coli 1
Older Than 3 Months
- Neisseria meningitidis
- Strep pneumo
- Haemophilus influenzae 1
Nosocomial
- Pseudomonas
- Fungal
- Translocated Gut Bacteria
- Coagulase Negative Staph 1
Assessment
Categorise patients into:
- Stable
- Respiratory Failure (compensated or decompensated)
- Cardiac Failure (compensated or decompensated)
- Cardiorespiratory Failure 1
Differentiate a collapse between ones due to sepsis and ones due to duct dependent lesion in neonates - you need an echo for this. In that situation starting prostaglandin is low risk. 1
Purpuric Rash
- Neisseria meningitidis 1
But also the following bugs can also cause it:
- Haemophilus influenzae
- Streptococcus pneumonia 1
Management
- Oxygen
- Vascular Access - Consider IO Access
- IV Fluids - 20ml/kg aliquots
- Vasopressors - After volume resuscitation (40-60ml/kg fluid) 1
Target variables:
Use the perfusion pressure: MAP-CVP = PP 1
Use the central venous oxygen saturation 1
Target inotropes to target perfusion pressure, age, and ScvO2 >70% 1
Dopamine usually first line agent in septic shock in paeds. 1
Also can consider a type III phosphodiesterase inhibitor for the refractory shocked patients 1
If catecholamine resistant start hydrocortisone (50mg/m2 - Stress Dose Hydrocortisone) 1
(Also In Adrenal Insufficiency give Hydrocortisone 1-2mg/kg 6hrly) 1
Extracorporeal Life Support?
In neonatal sepsis with refractory shock - 80% survival with ECLS 1
In paediatric septic refractory shock - 37-50% survival 1