Managem ent of paediatric severe sepsis-a brief overview Presented - - PowerPoint PPT Presentation

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Managem ent of paediatric severe sepsis-a brief overview Presented - - PowerPoint PPT Presentation

Nov 02, 2022 211 likes •352 views

Managem ent of paediatric severe sepsis-a brief overview Presented by: Radu Botgros, MD EMA Paediatric Coordinator, Infectious Diseases Specialist An agency of the European Union A.Control the source of infection Antibiotics Broad

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An agency of the European Union

Presented by: Radu Botgros, MD EMA Paediatric Coordinator, Infectious Diseases Specialist

Managem ent of paediatric severe sepsis-a brief

  • verview
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Management of paediatric severe sepsis 2

  • Antibiotics

– Broad spectrum – inappropriate cover  high mortality

  • Surgical

– Debridement – Drainage

A.Control the source of infection

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Management of paediatric severe sepsis 3

  • Before admission in the ICU
  • ICU

– Fluid resuscitation: early and aggressive – Inotropics – Respiratory support – Treatment of biochemical abnormalities – Hyperglycaemia – Other: hypo: Ca, K, Mg, PO4 – Correction of DIC

B.Management of shock

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Management of paediatric severe sepsis 4

  • Aggressive
  • Repeated if necessary
  • Human albumin solution 4,5%

– May be more effective than isotonic saline – HMW starches not to be used in children (cave renal)

a.Fluid resuscitation

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Management of paediatric severe sepsis 5

  • Initially dopamine, dobutamine via periph. vein
  • Adrenaline, noradrenaline via CVC

– After intubation

  • Vasopressin and vasopressin-like

b.Inotropics

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Management of paediatric severe sepsis 6

  • High-flow O2

– In all patients

  • Intubation and ventilation

– ARDS – Fluid refractory shock – Decreasing consciousness (GCS under 8 or loses 3 in 1h) – Other signs of raised intracranial pressure – Low tidal volume ventilation

c.Respiratory support

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Management of paediatric severe sepsis 7

  • hyperglycaemia

– Debatable if risk not greater than benefit

  • Hypoglycaemia
  • Hypocalcaemia
  • Hypomagnesemia
  • Hypophosphataemia

d.Treatment of biochemical abnormalities

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Management of paediatric severe sepsis 8

  • coagulopathy

– FFP – Platelets – Cryoprecipitate

  • Compartment syndrome

– Fasciotomy?

e.Treatment of DIC

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Management of paediatric severe sepsis 9

  • Meningitis?

– Fluid resuscitation if coexistent shock

  • Cerebral oedema?

– Avoid fluid resuscitation! – Mannitol

f.Treatment of raised intracranial pressure

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Management of paediatric severe sepsis 10

  • No aPC in children (RESOLVE study)
  • Corticosteroids?

– Generally not recommended – Always in meningitis

  • ECMO?

g.Other

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Management of paediatric severe sepsis 11

  • No aPC in children (RESOLVE study)
  • Corticosteroids?

– Generally not recommended – Always in meningitis

  • ECMO?

g.Other

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Management of paediatric severe sepsis 12

Curr Top Med Chem. 2008; 8(7): 603-14. New therapies for sepsis. Cunnington A, Nadel S.

References