Department of Clinical Infection, Microbiology and Immunology, University of Liverpool Institute of Infection, Veterinary and Ecological Sciences, Liverpool, United Kingdom.
Apollo Children's Hospital, Chennai, Tamil Nadu, India.
Pediatr Crit Care Med. 2023 Jun 1;24(6):e263-e271. doi: 10.1097/PCC.0000000000003263. Epub 2023 Apr 25.
Sepsis is a leading cause of global mortality in children, yet definitions for pediatric sepsis are outdated and lack global applicability and validity. In adults, the Sepsis-3 Definition Taskforce queried databases from high-income countries to develop and validate the criteria. The merit of this definition has been widely acknowledged; however, important considerations about less-resourced and more diverse settings pose challenges to its use globally. To improve applicability and relevance globally, the Pediatric Sepsis Definition Taskforce sought to develop a conceptual framework and rationale of the critical aspects and context-specific factors that must be considered for the optimal operationalization of future pediatric sepsis definitions. It is important to address challenges in developing a set of pediatric sepsis criteria which capture manifestations of illnesses with vastly different etiologies and underlying mechanisms. Ideal criteria need to be unambiguous, and capable of adapting to the different contexts in which children with suspected infections are present around the globe. Additionally, criteria need to facilitate early recognition and timely escalation of treatment to prevent progression and limit life-threatening organ dysfunction. To address these challenges, locally adaptable solutions are required, which permit individualized care based on available resources and the pretest probability of sepsis. This should facilitate affordable diagnostics which support risk stratification and prediction of likely treatment responses, and solutions for locally relevant outcome measures. For this purpose, global collaborative databases need to be established, using minimum variable datasets from routinely collected data. In summary, a "Think globally, act locally" approach is required.
脓毒症是导致全球儿童死亡的主要原因，但儿科脓毒症的定义已经过时，缺乏全球适用性和有效性。在成年人中，Sepsis-3 定义工作组查询了高收入国家的数据库，以制定和验证这些标准。该定义的优点已得到广泛认可；然而，在资源较少、更多样化的环境中，有一些重要的考虑因素对其在全球范围内的应用提出了挑战。为了提高全球适用性和相关性，儿科脓毒症定义工作组寻求制定一个概念框架和基本原理，阐明在未来儿科脓毒症定义的最佳实施中必须考虑的关键方面和特定背景因素。开发一组能够捕捉病因和潜在机制差异极大的疾病表现的儿科脓毒症标准，存在着诸多挑战。理想的标准应该是明确的，并且能够适应全球范围内存在疑似感染儿童的不同环境。此外，标准还需要促进早期识别和及时升级治疗，以防止病情恶化和限制危及生命的器官功能障碍。为了解决这些挑战，需要采用本地化的可适应解决方案，根据可用资源和脓毒症的前期预测概率，为每个儿童提供个性化的治疗方案。这应该有助于提供负担得起的诊断，支持风险分层和对可能的治疗反应进行预测，并提供适用于本地的结果衡量标准。为此，需要建立全球合作数据库，使用从常规收集的数据中提取的最小变量数据集。总之，需要采取“全球思考，本地化行动”的方法。
