Pediatric Sepsis Guidelines: summary for resource-limited countries

JOURNAL TITLE: Indian Journal of Critical Care Medicine

Author
1. Soonu Udani
2. Uma Ali
3. Rajiv Uttam
4. Satish Deopujari
5. Indumathi Santhanam
6. Krishan Chugh
7. Praveen Khilnani
8. Sunit Singhi
9. Rakesh Lodha
10. M. Jaishree
ISSN
0972-5229
DOI
10.4103/0972-5229.63029
Volume
14
Issue
1
Publishing Year
2010
Pages
12
Author Affiliations
    1. AIIMS, New Delhi, India
    2. All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
    3. All India Institute of Medical Sciences, New Delhi, e-mail: rakesh_lodha@hotmail.com
    4. AIIMS, Ansari Nagar, New Delhi
    5. All India Institutes of Medical Sciences (AIIMS), New Delhi, India
    6. All India Institute of Medical Sciences, New Delhi, India
    1. Fortis Memorial Research Institute, Gurugram, Haryana, India
    2. SGR Hospital, New Delhi, India
    3. Fortis Memorial Research Institute, Gurgaon, Haryana, India
    4. Institute of Health, Sir Ganga Ram Hospital, New Delhi
    5. Sir Ganga Ram Hospital, New Delhi, India
    6. Sir Ganga Ram Hospital, New Delhi, e-mail: chughk@bol.net.in
    7. Child Health, Sir Ganga Ram Hospital, New Delhi, India
    8. Sir Gangaram Hospital, New Delhi, India
    9. Sir Ganga Ram Hospital, Delhi, India
    10. Sir Ganga Ram Hospital, New Delhi
    11. Centre for Child Health, Sir Ganga Ram Hospital, New Delhi
    1. PD Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
    2. PD Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra
    3. Critical Care and Emergency Services, SRCC Children’s Hospital, Narayana Health, Mumbai, Maharashtra, India
    4. SRCC Children’s Hospital (Managed by Narayana Health), Mumbai, Maharashtra, India
    5. SRCC Children's Hospital, Mumbai, Maharashtra, India
    6. SRCC Children’s Hospital Managed by Narayana Health, Mumbai, Maharashtra, India
    7. PD Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
    8. PD Hinduja National Hospital and Medical Research Center, Mumbai, Maharashtra, India
    9. Hinduja Hospital, Mumbai, Maharashtra
    10. Hinduja Hospital, Mumbai, Maharashtra, India
    11. PD Hinduja National Hospital and Medical Research Centre, Mumbai; Grand Medical College, Mumbai, India
    12. PD Hinduja National Hospital and Medical Research Center, Mumbai, e-mail: dr_sudani@hindujahospital.com
    13. PD Hinduja Hospital, Mumbai, Maharashtra, India
    1. Child Hospital, Nagpur, Maharashtra, India
    2. Indira Gandhi Government Medical College and Hospital, Nagpur; VNIT, Nagpur; Nelson Mother and Child Hospital, Nagpur, Maharashtra, India
    3. Dhantoli, Nagpur, e-mail: deosat@nagpur.dot.net.in
    4. Central India’s Child Hospital and Research Institute, Nagpur, Maharashtra, India
    1. Fortis Hospitals, New Delhi, India
    2. Dr BL Kapoor Memorial Hospital, New Delhi, India
    3. MAX Superspeciality Hospital, New Delhi, India
    4. Max Super Speciality Hospital, New Delhi, India
    1. SRCC Children’s Hospital, Mumbai; Lilavati Hospital and Research Centre, Mumbai, Jupiter Hospital, Mumbai, Maharashtra, India
    2. Lilavati Hospital and Research Centre, Mumbai, Society for Rehabilitation of Crippled, Children (SRCC), Children’s Hospital, Mumbai, Jupiter Hospital, Thane, Maharashtra, India
    3. SRCC Children’s Hospital; Lilavati Hospital, Jupiter Hospital, Mumbai, Maharashtra, India
    4. BJ Wadia, Hospital for Children, Mumbai; Lilavati Hospital Mumbai, Jupiter Hospital, Thane, Maharashtra
    5. Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
    1. Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh
    2. Medanta—The Medicity, Gurugram, Haryana; Postgraduate Institute of Medical Education and Research, Chandigarh
    3. Medanta—The Medicity, Gurugram, Haryana; Postgraduate Institute of Medical, Education and Research, Chandigarh
    4. Medanta—The Medicity Hospital, Gurugram; Postgraduate Institute of Medical, Education and Research, Chandigarh, India
    5. Medanta—The Medicity, Gurugram; Postgraduate Institute of Medical Education and Research, Chandigarh, India
    6. Medanta—The Medicity, Gurugram, Haryana, India; Advanced, Pediatrics Center, Postgraduate Institute of Medical, Education and Research. Chandigarh, India
    7. Advanced Pediatric Centre, PGIMER, Chandigarh, Punjab, India
    8. Postgraduate Institute of Medical Education and Research, Chandigarh, India
    9. Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
    10. Advance Pediatric Center, Postgraduate Institute of Medical Educat
    1. Pediatric Critical Care and Pulmonology, BLK Superspeciality Hospital, New Delhi, India
    1. IAP (Intensive Care Chapter), B42 Panchsheel enclave New Delhi 110017, India
    1. IAP (Intensive Care Chapter), B42 Panchsheel enclave New Delhi 110017, India
  • Article keywords
    Pediatric, sepsis, septic shock

    Abstract

    Justification: Pediatric sepsis is a commonly encountered global issue. Existing guidelines for sepsis seem to be applicable to the developed countries, and only few articles are published regarding application of these guidelines in the developing countries, especially in resource-limited countries such as India and Africa. Process: An expert representative panel drawn from all over India, under aegis of Intensive Care Chapter of Indian Academy of Pediatrics (IAP) met to discuss and draw guidelines for clinical practice and feasibility of delivery of care in the early hours in pediatric patient with sepsis, keeping in view unique patient population and limited availability of equipment and resources. Discussion included issues such as sepsis definitions, rapid cardiopulmonary assessment, feasibility of early aggressive fluid therapy, inotropic support, corticosteriod therapy, early endotracheal intubation and use of positive end expiratory pressure/mechanical ventilation, initial empirical antibiotic therapy, glycemic control, and role of immunoglobulin, blood, and blood products. Objective: To achieve a reasonable evidence-based consensus on the basis of published literature and expert opinion to formulating clinical practice guidelines applicable to resource-limited countries such as India. Recommendations: Pediatric sepsis guidelines are presented in text and flow chart format keeping resource limitations in mind for countries such as India and Africa. Levels of evidence are indicated wherever applicable. It is anticipated that once the guidelines are used and outcomes data evaluated, further modifications will be necessary. It is planned to periodically review and revise these guidelines every 3-5 years as new body of evidence accumulates.

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