Pediatr Emerg Care. 2022 Sep 1;38(9):e1496-e1502. doi: 10.1097/PEC.0000000000002801. Epub 2022 Jul 7.
Sepsis is one of the most urgent health care issues worldwide. Guidelines for early identification and treatment are essential to decrease sepsis-related mortality. Our aim was to collect data on the epidemiology of pediatric septic shock (PSS) from the emergency department (PED) and to assess adherence to recommendations for its management in the first hour.
A multicenter, prospective, cross-sectional study was conducted evaluating children with PSS seen at the PED of 10 tertiary-care centers in Latin America. Adherence to guidelines was evaluated.
We included 219 patients (median age, 3.7 years); 43% had comorbidities, 31% risk factors for developing sepsis, 74% clinical signs of "cold shock," and 13% of "warm shock," 22% had hypotension on admission. Consciousness was impaired in 55%. A peripheral line was used as initial access in 78% (median placement time, 10 minutes). Fluid and antibiotics infusion was achieved within a median time of 30 minutes (interquartile range [IQR], 20-60 minutes) and 40 minutes (IQR, 20-60 minutes), respectively; 40% responded inadequately to fluids requiring vasoactive drugs (median time at initiation, 60 minutes; IQR, 30-135 minutes). Delay to vasoactive drug infusion was significantly longer when a central line was placed compared to a peripheral line (median time, 133 minutes [59-278 minutes] vs 42 minutes [30-70 minutes], respectively [ P < 0.001]). Adherence to all treatment goals was achieved in 13%. Mortality was 10%. An association between mortality and hypotension on admission was found (26.1% with hypotension vs 4.9% without; P < 0.001).
We found poor adherence to the international recommendations for the treatment of PSS in the first hour at the PED in third-level hospitals in Latin America.
脓毒症是全球最紧迫的医疗保健问题之一。制定早期识别和治疗的指南对于降低脓毒症相关死亡率至关重要。我们的目的是从急诊科（PED）收集儿科脓毒性休克（PSS）的流行病学数据，并评估在最初 1 小时内管理该病的建议的遵循情况。
进行了一项多中心、前瞻性、横断面研究，评估了来自拉丁美洲 10 家三级保健中心 PED 的 219 例 PSS 患儿。评估了指南的遵循情况。
共纳入 219 例患儿（中位年龄 3.7 岁）；43%存在合并症，31%存在发生脓毒症的危险因素，74%有“冷休克”的临床体征，13%有“暖休克”，22%入院时低血压。55%意识受损。78%（中位置管时间 10 分钟）作为初始入路使用外周静脉。液体和抗生素输注分别在中位时间 30 分钟（20-60 分钟）和 40 分钟（20-60 分钟）内完成；40%对液体反应不足，需要血管活性药物（中位起始时间 60 分钟，30-135 分钟）。与外周静脉相比，中心静脉置管时血管活性药物输注的延迟时间显著更长（中位时间分别为 133 分钟[59-278 分钟]和 42 分钟[30-70 分钟]，P<0.001）。仅 13%达到所有治疗目标。死亡率为 10%。入院时低血压与死亡率相关（低血压者 26.1%，无低血压者 4.9%，P<0.001）。
我们发现拉丁美洲三级医院 PED 在最初 1 小时内治疗 PSS 的国际指南的遵循情况较差。
