Pediatric Critical Care, Primary Children's Medical Center, Salt Lake City, UT 84158-0289, USA.
Pediatrics. 2011 Jun;127(6):e1585-92. doi: 10.1542/peds.2010-3513. Epub 2011 May 16.
Unrecognized and undertreated septic shock increases morbidity and mortality. Septic shock in children is defined as sepsis and cardiovascular organ dysfunction, not necessarily with hypotension.
Cases of unrecognized and undertreated septic shock in our emergency department (ED) were reviewed with a focus on (1) increased recognition at triage and (2) more aggressive treatment once recognized. We hypothesized that septic shock protocol and care guideline would expedite identification of septic shock, increase compliance with recommended therapy, and improve outcomes.
We developed an ED septic shock protocol and care guideline to improve recognition beginning at triage and evaluated all eligible ED patients from January 2005 to December 2009.
We identified 345 pediatric ED patients (49% male, median age: 5.6 years), and 297 (86.1%) met septic shock criteria at triage. One hundred ninety-six (56.8%) had ≥ 1 chronic complex condition. Hypotension was present in 34% (n = 120); the most common findings were tachycardia (n = 251 [73%]) and skin-color changes (n = 269 [78%]). The median hospital length of stay declined over the study period (median: 181-140 hours; P < .05); there was no change in mortality rate, which averaged 6.3% (22 of 345). The greatest gains in care included more complete recording of triage vital signs, timely fluid resuscitation and antibiotic administration, and serum lactate determination.
Implementation of an ED septic shock protocol and care guideline improved compliance in delivery of rapid, aggressive fluid resuscitation and early antibiotic and oxygen administration and was associated with decreased length of stay.
未被识别和治疗不足的感染性休克会增加发病率和死亡率。儿童感染性休克的定义为败血症和心血管器官功能障碍，不一定伴有低血压。
回顾我院急诊科（ED）中未被识别和治疗不足的感染性休克病例，重点关注（1）分诊时的更高识别率，以及（2）一旦识别后的更积极治疗。我们假设感染性休克方案和护理指南将加快感染性休克的识别，提高对推荐治疗的依从性，并改善结局。
我们制定了 ED 感染性休克方案和护理指南，以改善分诊时的识别，并评估了 2005 年 1 月至 2009 年 12 月期间所有符合条件的 ED 患者。
我们共确定了 345 例儿科 ED 患者（49%为男性，中位数年龄为 5.6 岁），297 例（86.1%）在分诊时符合感染性休克标准。196 例（56.8%）存在≥1 种慢性复杂疾病。34%（n=120）存在低血压；最常见的发现是心动过速（n=251 [73%]）和皮肤颜色改变（n=269 [78%]）。研究期间，医院住院时间中位数缩短（中位数：181-140 小时；P<.05）；死亡率无变化，平均为 6.3%（345 例中的 22 例）。在护理方面的最大改进包括更完整地记录分诊生命体征、及时进行液体复苏和抗生素治疗以及血清乳酸测定。
实施 ED 感染性休克方案和护理指南可提高快速、积极的液体复苏以及早期抗生素和氧气治疗的依从性，并与住院时间缩短相关。
