Burgunder Lauren, Heyrend Caroline, Olson Jared, Stidham Chanelle, Lane Roni D, Workman Jennifer K, Larsen Gitte Y
Division of Pediatric Critical Care, Department of Pediatrics, Primary Children's Hospital, University of Utah, 100 North Mario Capecchi Drive, Salt Lake City, UT, 84113, USA.
Division of Primary Children's Hospital Pharmacy, Salt Lake City, UT, USA.
Paediatr Drugs. 2022 May;24(3):193-205. doi: 10.1007/s40272-022-00497-z. Epub 2022 Mar 21.
Sepsis is a life-threatening response to infection that contributes significantly to neonatal and pediatric morbidity and mortality worldwide. The key tenets of care include early recognition of potential sepsis, rapid intervention with appropriate fluids to restore adequate tissue perfusion, and empiric antibiotics to cover likely pathogens. Vasoactive/inotropic agents are recommended if tissue perfusion and hemodynamics are inadequate following initial fluid resuscitation. Several adjunctive therapies have been suggested with theoretical benefit, though definitive recommendations are not yet supported by research reports. This review focuses on the recommendations for medication and fluid management of pediatric sepsis and septic shock, highlighting issues related to antibiotic choices and antimicrobial stewardship, selection of intravenous fluids for resuscitation, and selection and use of vasoactive/inotropic medications. Controversy remains regarding resuscitation fluid volume and type, antibiotic choices depending upon infectious risks in the patient's community, and adjunctive therapies such as vitamin C, corticosteroids, intravenous immunoglobulin, and methylene blue. We include best practice recommendations based on international guidelines, a review of primary literature, and a discussion of ongoing clinical trials and the nuances of therapeutic choices.
脓毒症是一种危及生命的感染反应，在全球范围内对新生儿和儿童的发病率及死亡率有重大影响。护理的关键原则包括早期识别潜在脓毒症、迅速使用适当液体进行干预以恢复足够的组织灌注，以及使用经验性抗生素覆盖可能的病原体。如果在初始液体复苏后组织灌注和血流动力学仍不足，建议使用血管活性/正性肌力药物。尽管研究报告尚未支持明确的建议，但已有几种具有理论益处的辅助治疗方法被提出。本综述重点关注儿童脓毒症和脓毒性休克的药物及液体管理建议，突出与抗生素选择和抗菌药物管理、复苏用静脉输液的选择以及血管活性/正性肌力药物的选择和使用相关的问题。关于复苏液的容量和类型、根据患者所在社区的感染风险选择抗生素以及维生素C、皮质类固醇、静脉注射免疫球蛋白和亚甲蓝等辅助治疗方法仍存在争议。我们纳入了基于国际指南的最佳实践建议、对原始文献的综述，以及对正在进行的临床试验和治疗选择细微差别的讨论。
