San Geroteo Julian, Levy Michael, Bailhache Marion, De Jorna Claire, Privat Elodie, Gasmi Oussama, Fuentes-Lopez Maria, Laoudi Yacine, Mazeghrane Mustapha, Malterre Aline, Bories Pauline, Abdel Aal Khaled, Arjoca Iozefina, Gaschignard Jean, Tanchaleune Davy, Minodier Philippe, Audren Fabien, Mazetier Tifanny, Quagliaro Pauline, Raimond Florence, Sieng Soria, Robert Blandine, Wohrer Delphine, De Suremain Nathalie, Dauger Stéphane
Pediatric Intensive Care Unit, Robert-Debré Mother-Child University Hospital, Paris, France
Pediatric Intensive Care Unit, Robert-Debré Mother-Child University Hospital, Paris, France.
Arch Dis Child. 2024 Jul 18;109(8):636-641. doi: 10.1136/archdischild-2023-325837.
Paediatric sepsis is the leading cause of death in children under 5 years. No studies have evaluated the application of the Surviving Sepsis Campaign 2020 (SSC-2020) guidelines in paediatric emergency departments (PEDs).
To assess physician adherence to the SSC-2020 fluid resuscitation guidelines in children with suspected septic shock in PEDs.
This was a prospective multicentre observational study conducted in 21 French hospitals over 5 sequential weeks, between November 2021 and March 2022. Children with suspected septic shock and who received antimicrobial therapy within 72 hours were included. Primary outcome was SSC-2020 fluid resuscitation guidelines adherence (low 0-24%; moderate 25-74%; high 75-100%) according to: bolus volume of 10-20 mL/kg each, exclusive administration of balanced crystalloids at 1 and 24 hours of management, and initiation of fluid resuscitation within 1 hour of septic shock recognition.
63 children were included. 10 (16%) children had severe sepsis and 2 (3%) met the definition of septic shock. Compared with the SSC-2020 guidelines, 43 (68%) patients received boluses of 10-20 mL/kg; fluid resuscitation was initiated within 1 hour of septic shock recognition in 42 (76%) cases; balanced crystalloids were the only fluids administrated in 35 (56%) and 34 (55%) children at 1 and 24 hours of management, respectively. Main barriers reported by physicians were difficult intravenous access (43%), lack of team training (29%), workload constraints (28%), and absence or out-of-date protocols (24%).
This study found high adherence for fluid resuscitation initiation but moderate adherence for bolus volume and fluid choice.
NCT05066464.
儿童脓毒症是5岁以下儿童死亡的主要原因。尚无研究评估《2020年拯救脓毒症运动（SSC - 2020）》指南在儿科急诊科（PEDs）中的应用情况。
评估儿科急诊科中医生对疑似感染性休克儿童的SSC - 2020液体复苏指南的遵循情况。
这是一项前瞻性多中心观察性研究，于2021年11月至2022年3月期间在法国21家医院连续进行了5周。纳入疑似感染性休克且在72小时内接受抗菌治疗的儿童。主要结局是根据以下标准对SSC - 2020液体复苏指南的遵循情况（低0 - 24%；中25 - 74%；高75 - 100%）：每次推注量为10 - 20 mL/kg，在治疗1小时和24小时时仅给予平衡晶体液，以及在识别感染性休克后1小时内开始液体复苏。
纳入63名儿童。10名（16%）儿童患有严重脓毒症，2名（3%）符合感染性休克的定义。与SSC - 2020指南相比，43名（68%）患者接受了10 - 20 mL/kg的推注；42名（76%）病例在识别感染性休克后1小时内开始液体复苏；分别有35名（56%）和34名（55%）儿童在治疗1小时和24小时时仅接受了平衡晶体液。医生报告的主要障碍包括静脉穿刺困难（43%）、缺乏团队培训（29%）、工作量限制（28%）以及方案缺失或过时（24%）。
本研究发现液体复苏开始的遵循率高，但推注量和液体选择的遵循率中等。
NCT05066464。
