Instituto da Criança, University of São Paulo, São Paulo, Brazil.
Shock. 2010 Sep;34 Suppl 1:44-7. doi: 10.1097/SHK.0b013e3181e7e6d5.
In the whole world, around 29,000 children younger than 5 years die every day, and sepsis is the most common cause of death. Whereas in adult patients vasomotor paralysis represents the predominant cause of mortality, death in pediatric sepsis is associated with severe hypovolemia and low cardiac output. The purpose of this article was to review the recent evidence on early treatment of pediatric severe sepsis and septic shock. Although current American College of Critical Care Medicine-Pediatric Advanced Life Support guidelines represent best practice, stronger evidences are lacking to confirm the components of these recommendations. Retrospective studies showed, at the same time, the positive effects arising from the utilization of American College of Critical Care Medicine-Pediatric Advanced Life Support guidelines and the existing barriers to its implementation. And one randomized control trial paralleled the results observed in adult patients and revealed that early goal-directed therapy in children is one of the few therapeutic interventions that proved to be beneficial in septic shock treatment. Early goal-directed therapy in pediatric septic shock is a successful method to optimize and parameterize treatment, but there is still a long way to turn septic shock resuscitation simpler and more widely spread.
在全球范围内，每天约有 29000 名 5 岁以下儿童死亡，而败血症是最常见的死亡原因。然而，在成年患者中，血管运动麻痹是导致死亡的主要原因，而儿科败血症死亡与严重低血容量和低心输出量有关。本文旨在回顾儿科严重败血症和败血症休克的最新治疗证据。尽管目前的美国危重病医学会-儿科高级生命支持指南代表了最佳实践，但缺乏更强有力的证据来证实这些建议的组成部分。回顾性研究同时表明，利用美国危重病医学会-儿科高级生命支持指南的积极效果以及其实施存在的障碍。一项随机对照试验与在成年患者中观察到的结果相平行，表明儿童早期目标导向治疗是为数不多的已被证明对败血症休克治疗有益的治疗干预措施之一。儿科败血症休克的早期目标导向治疗是优化和参数化治疗的成功方法，但仍有很长的路要走，以使败血症休克复苏更简单和更广泛地传播。
