Article Text
Abstract
Background Paediatric sepsis is the leading cause of death in children under 5 years. No studies have evaluated the application of the Surviving Sepsis Campaign 2020 (SSC-2020) guidelines in paediatric emergency departments (PEDs).
Objective To assess physician adherence to the SSC-2020 fluid resuscitation guidelines in children with suspected septic shock in PEDs.
Methods This was a prospective multicentre observational study conducted in 21 French hospitals over 5 sequential weeks, between November 2021 and March 2022. Children with suspected septic shock and who received antimicrobial therapy within 72 hours were included. Primary outcome was SSC-2020 fluid resuscitation guidelines adherence (low 0–24%; moderate 25–74%; high 75–100%) according to: bolus volume of 10–20 mL/kg each, exclusive administration of balanced crystalloids at 1 and 24 hours of management, and initiation of fluid resuscitation within 1 hour of septic shock recognition.
Results 63 children were included. 10 (16%) children had severe sepsis and 2 (3%) met the definition of septic shock. Compared with the SSC-2020 guidelines, 43 (68%) patients received boluses of 10–20 mL/kg; fluid resuscitation was initiated within 1 hour of septic shock recognition in 42 (76%) cases; balanced crystalloids were the only fluids administrated in 35 (56%) and 34 (55%) children at 1 and 24 hours of management, respectively. Main barriers reported by physicians were difficult intravenous access (43%), lack of team training (29%), workload constraints (28%), and absence or out-of-date protocols (24%).
Conclusions This study found high adherence for fluid resuscitation initiation but moderate adherence for bolus volume and fluid choice.
Trial registration number NCT05066464.
- Sepsis
- Paediatric Emergency Medicine
- Paediatrics
- Intensive Care Units, Paediatric
- Emergency Care
Data availability statement
Data are available upon reasonable request.
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Data availability statement
Data are available upon reasonable request.
Footnotes
Presented at This work was presented at the 2023 French Intensive Care Society International Congress.
Contributors JSG and SD conceptualised and designed the study and drafted the initial manuscript. JSG designed the data collection instruments and carried out the initial analyses. ML reviewed all medical files of children admitted to PICU and revised the manuscript. All authors collected data, critically reviewed the manuscript and gave their approval of the final version. JSG is the guarantor and accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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