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Septic shock in children: Ongoing management after resuscitation

Authors
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

INTRODUCTION

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 in children: Rapid recognition and initial resuscitation (first hour)" and "Systemic inflammatory response syndrome (SIRS) and sepsis in children: Definitions, epidemiology, clinical manifestations, and diagnosis".)

RESUSCITATION

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

INSTITUTIONAL "BUNDLE" FOR STABILIZATION BEYOND THE FIRST HOUR

Each pediatric institution should develop a multidisciplinary approach to the ongoing management of children with septic shock. Key aspects of the bundle include multimodal monitoring to optimize therapies designed to achieve hemodynamic goals (table 1) and to confirm appropriate treatment of infection (ie, appropriate antimicrobial therapy and source control [1].

APPROACH TO ONGOING MANAGEMENT

Whenever possible, children requiring resuscitation for septic shock should receive ongoing management by a pediatric critical care specialist or pediatrician with similar expertise in a pediatric intensive care unit (PICU).

Repeated, frequent assessment of the patient in septic shock is essential to good outcomes. In children who have responded to initial resuscitation in the first hour with resolution of hypotension, ongoing monitoring, antimicrobial therapy, and optimal respiratory support must continue.

                       

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Literature review current through: Aug 2017. | This topic last updated: Aug 30, 2017.
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