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Septic shock: Ongoing management after resuscitation in children

Scott L Weiss, MD
Wendy J Pomerantz, MD, MS
Section Editors
Susan B Torrey, MD
Adrienne G Randolph, MD, MSc
Sheldon L Kaplan, MD
Deputy Editor
James F Wiley, II, MD, MPH


Sepsis is a clinical syndrome complicating severe infection that is characterized by systemic inflammation, immune dysregulation, microcirculatory derangements, and end-organ dysfunction. There is a continuity of severity ranging from sepsis to severe sepsis and septic shock. Severe sepsis and septic shock are characterized by dysfunction of ≥2 organ systems and cardiovascular dysfunction, respectively [1]. With increased attention to rapid recognition, aggressive fluid administration, and early administration of vasoactive agents and antibiotics, pediatric mortality from severe sepsis and septic shock has decreased markedly [2-7].

The management of severe sepsis and septic shock in children after the first hour of resuscitation is reviewed here. The rapid recognition and initial resuscitation of pediatric septic shock and the definitions, epidemiology, and clinical manifestations of sepsis in children are discussed separately. (See "Septic shock: Rapid recognition and initial resuscitation in children" and "Systemic inflammatory response syndrome (SIRS) and sepsis in children: Definitions, epidemiology, clinical manifestations, and diagnosis".)


The key interventions in the initial resuscitation of children from septic shock are discussed in detail separately. (See "Septic shock: Rapid recognition and initial resuscitation in children".)


The American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock are available [8]. These recommendations update the 2007 guidelines for treatment of septic shock in children. This topic is currently undergoing revision based upon the new guidance.  


Repeated, frequent assessment of the patient in septic shock is essential. In children who have responded to therapy with resolution of hypotension, ongoing monitoring, antimicrobial therapy, and optimal respiratory support are essential.


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Literature review current through: Jun 2017. | This topic last updated: May 19, 2017.
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