Mathias Brittany, Mira Juan C, Larson Shawn D
Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA.
Curr Opin Pediatr. 2016 Jun;28(3):380-7. doi: 10.1097/MOP.0000000000000337.
Sepsis is the leading cause of pediatric death worldwide. In the United States alone, there are 72 000 children hospitalized for sepsis annually with a reported mortality rate of 25% and an economic cost estimated to be $4.8 billion. However, it is only recently that the definition and management of pediatric sepsis has been recognized as being distinct from adult sepsis.
The definition of pediatric sepsis is currently in a state of evolution, and there is a large disconnect between the clinical and research definitions of sepsis which impacts the application of research findings into clinical practice. Despite this, it is the speed of diagnosis and the timely implementation of current treatment guidelines that has been shown to improve outcomes. However, adherence to treatment guidelines is currently low and it is only through the implementation of protocols that improved care and outcomes have been demonstrated.
The current management of pediatric sepsis is largely based on adaptations from adult sepsis treatment; however, distinct physiology demands more prospective pediatric trials to tailor management to the pediatric population. Adherence to current and emerging practice guidelines will require that protocolized care pathways become a commonplace.
脓毒症是全球儿童死亡的主要原因。仅在美国，每年就有7.2万名儿童因脓毒症住院，报告的死亡率为25%，经济成本估计为48亿美元。然而，直到最近，儿童脓毒症的定义和管理才被认为与成人脓毒症不同。
儿童脓毒症的定义目前处于演变状态，脓毒症的临床定义和研究定义之间存在很大脱节，这影响了研究结果在临床实践中的应用。尽管如此，已证明提高诊断速度并及时实施当前治疗指南可改善预后。然而，目前对治疗指南的依从性较低，只有通过实施方案才能证明可改善护理和预后。
目前儿童脓毒症的管理主要基于对成人脓毒症治疗方法的调整；然而，独特的生理机能需要更多前瞻性的儿科试验，以便为儿童群体量身定制管理方案。要遵循当前和新出现的实践指南，就需要将规范化护理路径变成常态。
