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may contribute to different outcomes. Timely early recognition of pediatric sepsis has been identified as a crucial step in sepsis management, and so this clinical pathway was developed as an adaptation from several sources to improve the care of pediatric patients presenting with signs of sepsis at Johns Hopkins All Children’s Hospital.
clinical diagnosis is fluid-refractory shock (i.e., septic shock). 1. Inotropes and/or vasopressor infusions should be initiated with: a. Fluid-refractory shock b. Fluid overload during the fluid resuscitation. 2. Vasoactive agents are chosen based on whether the child is in cold shock or warm shock. a.
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Jan 2, 2012 · Indeed, early recognition of septic shock and institution of antibiotic therapy can reduce mortality in children. Furthermore, early institution of resuscitative measures, particularly by using aggressive fluid replacement strategies, may prevent the child from entering uncompensated or irreversible shock, thereby reducing morbidity and mortality.
- Paolo Biban, Marcella Gaffuri, Stefania Spaggiari, Federico Zaglia, Alessandra Serra, Pierantonio Sa...
- 2012
Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock: 2017 Update from the American College of Critical Care Medicine ; Sepsis References; Nutrition References; Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2017
- Conflict of Interest
- Agenda
- Learning Objectives
- Background
- Adults
- Children
- Creating a Pediatric Sepsis Detection Algorithm
- Project Goal
- Partnering with the Vendor
- Challenges
- Neurologic Dysfunction
- Defining gold standard sepsis cohort
- Algorithm Performance
- Implementation into Clinical Workflows
- +SIRS/SEPSIS ALERT
- What’s next
- EMR Team
- Questions
Statistical and project management support for this study were provided by an electronic medical record vendor Drs. Madden and Eisenberg received no financial support and have no other disclosures or conflicts of interest
Background Creating a pediatric sepsis detection algorithm Algorithm performance Implementation into clinical workflows Future directions
Recognize the process used to develop and evaluate the pediatric sepsis algorithm at Boston Children’s Hospital Describe the range of operating characteristics of the pediatric sepsis algorithm based on different changes to the algorithm Identify the strategy for inserting the algorithm into clinical workflows Discuss the plans to iterate on the al...
Pediatric vs. adult sepsis Quality improvement efforts in pediatric sepsis
Sepsis identification tools based on one set of criteria Organ dysfunction included in sepsis definition Hypotension an earlier sign
Vital sign & lab criteria differ based on age groups Tools must incorporate many different age-based cutoffs Organ dysfunction a later sign Hypotension occurs late Paul,
Algorithm creation Defining sepsis “gold standard”
Develop an automated sepsis screening tool to alert clinicians of children at risk of severe sepsis Earlier detection Prevent missed cases more rapid intervention
Vendor had pre-existing adult sepsis screening tool Not designed for use in children Vendor team Performance improvement strategists Statisticians BCH team Critical care and emergency medicine physicians
Difficult to distinguish sepsis from vital signs/labs alone Most detection tools have low specificity High risk of alarm fatigue Sepsis and severe sepsis are not easily defined Gold standard needed to evaluate tool performance Diagnosis codes inaccurate
Mental Status identified as Decreased, Irritability, Confusion, inappropriate crying or drowsiness, poor interaction with parents, lethargy, diminished arousability, or obtunded (ALTERED_MENTAL_STATUS_CLIN, IRRITABILITY_CLIN, CONFUSION_CLIN, LETHARGY_CLIN, CRYING_EXCESSIVE_OR_INAPPROPRIATE_CLIN, DROWSINESS_CLIN, OBTUNDED_CLIN)
No single test defines sepsis ICD codes are inaccurate Defined gold standard by clinician “intention to treat” severe sepsis Also adopted by IPSO sepsis collaborative
Performance of the initial algorithm Iterations to improve performance Final performance characteristics
Current state Implementation in the emergency department
Alert goes to attending, trainee and RN assigned on tracking board No assignment Any RN with “relationship”
Continued cycles of improvement Adding to the model to further improve PPV Risk of infection History of chemo order, indwelling lines Suspected infection Microbial test or antimicrobial given Changes in vital signs What’s next Complete ED implementation and evaluate Prospective study ongoing Outcomes: missed cases, timeliness of interventions, ICU ...
Jeff Christianson, PhD Abbey Logan, Strategist Justin Kimbrell, Sr. Strategist
Contact Info: matthew.eisenberg@childrens.harvard.edu kate.madden@childrens.harvard.edu Please complete online session evaluation
- 1MB
- 50
Jan 5, 2021 · Management. The most important aspects of medical therapy for patients with septic shock in the ICU setting are underpinned by crystalloid fluid administration, early administration of broad-spectrum antibiotics, adequate oxygen delivery, rapid source identification and control, and support of organ failure or dysfunction. 12, 24, 51 – 53.
Feb 9, 2019 · This chapter provides recommendations on the management of pediatric sepsis in intensive care units (ICUs) in resource-limited settings. Rapidly identification of severe sepsis through a combination of danger signs of end-organ dysfunction or impaired circulation is vital to improve outcome. Better scoring systems for risk stratification tailored for resource-poor settings are needed. Rapid ...
