Do we follow the surviving sepsis campaign guidelines 2008 in paediatric icu?

Abstract

Background and aims: Sepsis and septic shock requires urgent and adequate management. The aim of the study was to audit current management of severe sepsis/septic shock in paediatric ICU. Methods: Retrospective observational study of medical care of patients with severe sepsis/septic shock, treated in single paediatric ICU.Results: Records of 28 patients were audited: 8 (28.6%) with severe sepsis, and 20 (71.4%)—septic shock. Admitted with communityacquired severe infection—24 (85.7%). Blood cultures were taken for all patients. The median predicted mortality (PIM2) was 3.5% (IQR 15.63), the observed mortality was higher (7, 25%, p = 0.03). The average total fluid (ml/kg) given during the 1, 6 and 24 h period was as follows: 21.43 (SD 17.94), 74.85 (SD 48.43) and 164.37 (SD 81.53). The fluid\100 ml/h given during the 6 h period was significant factor for the lethal outcome (OR 6.25, 95% CI: 2.78-23.26). Inotropes/vasoactive drugs were prescribed in 23 (79.6%) patients, and most of them 22 (95.0%) were Dopamine or Dobutamine. The median time-period until the first antimicrobial was given resulted in 0.29 (IQR 0.95) hour, meaning that 23 (82.1%) patients received antimicrobials during the first hour. Conclusions: Observed mortality was higher than predicted, and the patients were under-resuscitated with the fluids during the first hour of admission; in general, prescription of the antimicrobials followed the guideline.