Pediatric intensive care unit physicians audit on management of septic shock

Abstract

Background and aims Surviving sepsis campaign and American College of Critical Medicine guidelines for the management of pediatric septic shock patients are an indisputable progress. Some issues remain questionable limiting strict adherence to these recommendations. We conducted a survey among the European Society of Pediatric and Neonatal Intensive Care members to identify and explain some of these debatable issues. Methods 114 pediatric intensive care unit physicians completed clinical cases based electronic survey. They provided their clinical attitude facing six different situations in the management of a child with septic shock. Results The types of fluids used as a fourth volume expansion were preferentially non-synthetic colloids (albumin) and crystalloids (isotonic saline). Early and systematic intubation for mechanical ventilation was approved by 70% of the participants. While dopamine or epinephrine are recommended as first line vasopressors in pediatric septic shock, norepinephrine was the drug of choice for 94% of the PICU physicians. The addition of an inotrope was frequent (80%). Specific drugs such as vasopressin or enoximone are not routinely used in septic shock, despite their appearance in the consensus management algorithm. The use of high-flow hemofiltration is subject to debate. Extracorporeal membrane oxygenation was used or considered for use by 91% of the physicians audited in certain specific situations. Conclusions Considerable doubt exists regarding appropriate management of pediatric septic shock due to a lack of evidence exhorting the need for high quality collaborative studies to answer these important questions.L6138859612017-01-02 <br />