Ventura Andrea Maria Cordeiro, Araujo Orlei Ribeiro, Colleti Junior José, Souza Daniela Carla de
Hospital Universitário, Universidade de São Paulo - São Paulo (SP), Brazil.
Grupo de Apoio ao Adolescente e à Criança com Câncer, Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo - São Paulo (SP), Brazil.
Crit Care Sci. 2025 Mar 17;37:e20250143. doi: 10.62675/2965-2774.20250143. eCollection 2025.
To evaluate the ability of Brazilian pediatricians to recognize sepsis and septic shock in children.
A cross-sectional multicenter survey was conducted among Brazilian pediatricians between May and June 2023, before the release of the new Phoenix sepsis criteria in 2024. An online electronic system was used for surveys to characterize the knowledge and skills of physicians in the diagnosis and treatment of sepsis in children. The questions related to the diagnosis and treatment of sepsis and septic shock in children were based on the International Pediatric Sepsis Consensus Conference, the American College of Critical Care Medicine Guidelines, and the Surviving Sepsis Campaign in Pediatrics. Descriptive statistical analyses were performed using R software.
Pediatricians were surveyed about the recognition, knowledge, and management of pediatric patients with sepsis and septic shock. The responses of 355 physicians from all regions of Brazil were analyzed, with the majority from the southeastern region of the country (53.3%). In clinical practice, the most utilized criteria for diagnosing sepsis included inappropriate tachycardia (92%), temperature alteration (88.2%), and the presence of a suspected or confirmed infectious focus (87.9%). For septic shock, capillary refill time alteration (87.1%), arterial hypotension (84.8%), and changes in the level of consciousness (82.2%) were the predominant indicators. A total of 55.6% pediatricians reported having the potential to obtain venous or intraosseous access within 5 minutes, and 59.3% could administer antibiotics within the first hour. Approximately one-quarter (27.5%) of the participants responded that it was possible to infuse 40 - 60mL/kg in 1 hour. The most commonly used solution for fluid resuscitation was isotonic saline (70.9%), followed by Ringer's lactate (45.0%). The infusion of a vasopressor was considered in patients who did not improve after receiving an infusion of 40 - 60mL/kg (75.8%).
This is the first study to assess the knowledge of sepsis and septic shock among the Brazilian pediatric population. The results reveal a significant deficiency in the recognition of sepsis. This study demonstrated a gap between evidence and clinical practice. Adherence to international guidelines needs to be improved.
评估巴西儿科医生识别儿童脓毒症和脓毒性休克的能力。
在2024年新的菲尼克斯脓毒症标准发布之前，于2023年5月至6月对巴西儿科医生进行了一项横断面多中心调查。使用在线电子系统进行调查，以描述医生在儿童脓毒症诊断和治疗方面的知识和技能。有关儿童脓毒症和脓毒性休克诊断与治疗的问题基于国际儿童脓毒症共识会议、美国危重病医学会指南以及儿科拯救脓毒症运动。使用R软件进行描述性统计分析。
对儿科医生进行了关于儿童脓毒症和脓毒性休克的识别、知识及管理方面的调查。分析了来自巴西所有地区的355名医生的回复，其中大多数来自该国东南部地区（53.3%）。在临床实践中，诊断脓毒症最常用的标准包括心动过速异常（92%）、体温改变（88.2%）以及存在疑似或确诊的感染灶（87.9%）。对于脓毒性休克，毛细血管再充盈时间改变（87.1%）、动脉低血压（84.8%）和意识水平变化（82.2%）是主要指标。共有55.6%的儿科医生报告有可能在5分钟内获得静脉或骨内通路，59.3%的医生能够在第一小时内使用抗生素。约四分之一（27.5%）的参与者回答有可能在1小时内输注40 - 60mL/kg。液体复苏最常用的溶液是等渗盐水（70.9%），其次是乳酸林格液（45.0%）。在输注40 - 60mL/kg后病情无改善的患者中，75.8%的医生考虑使用血管升压药。
这是第一项评估巴西儿科人群中脓毒症和脓毒性休克知识的研究。结果显示在脓毒症识别方面存在重大不足。本研究表明证据与临床实践之间存在差距。需要提高对国际指南的遵循程度。
