6.2 Paediatric Sepsis Flashcards
What are the risk factors of paediatric sepsis?
- Neonates
- Immunodefiency/supressed e.g. oncology or asplenic patients
- Central lines
- Unvaccinated
What does infection cause?
Invasion and multiplications triggers an inflammatory response
What are the common causes of infection in paediatrics?
Urine
Chest
ENT
Skin
Lines
Blood
GI
What is systemic inflammatory response syndrome (SIRS)?
Inflammatory cascade
- Caused by inadequate recognition and/or elimination of trigger
With at least 2 of the following:
- Temperature >38.5 or < 36
- Tachycardia
- Tachypnoea
- Raised or lowered white cell count
What causes SIRS?
- Infections
- Burns
- Arrhythmia
- Heart failure
- Dehydration
- Diabetes
- Hypoglycaemia
- Poisoning
- Guillain-Barre syndrome
What is the paediatric definition of sepsis?
Suspected or provgen infection associated with a systemic inflammatory response
Infection + 2 of SIRS criteria = sepsis
What is severe sepsis?
Sepsis + organ dysfunction e.g. cardiovascular or respiratory
What is septic shock?
Sepsis + cardiovascular organ dysfunction
What is the pathophysiology of septic shock leading to death?
Infection causes release of toxins
Activation of inflammatory cells causing host defence activation
Inflammatory cytokines are released
Activation of complement and coagualation systems
Activation of endothelium leading to decreased thrombomodulin
Hypovolaemia
Shock
Multiorgan dysfunction syndrome
Death
What are the challenges of identifying sepsis in paediatrics?
SIRS criteria not sepsis specific
Deterioration can occur very quickly
May be difficult to identify unwell child e.g.
- Cheerful, playful, tachycardic at rest
- Several sepsis mimics
What temperature indicates fever?
38 degrees
38.5 is more specific for sepsis
What thermometers are used for paediatrics?
Electric thermometer in axilla- any age
Infared tympanic >4months
Chemical dot thermometer in axilla >4months
Parental temperature report is valid
What is sepsis 6?
BUFALO
Take bloods
Measure urine output
Give IV fluids
Give broad spectrum antibiotics
Take lactate levels
Give oxygen
Escalate to senior, consider inotropes early on
How quickly does the sepsis 6 bundle need to be completed?
Within 1 hour, mortality is lowered
How is oxygen given in the sepsis 6 bundle?
Facemask
Aim for more than 94%
How do you get IV access?
Peripheral cannula- difficult in children especially those with sepsis
Intraosseous
What bloods are taken in sepsis?
FBC
U&Es
CRP
Clotting
Glucose
Lactate
Blood culture
What other samples may be taken in sepsis?
CSF
Urine
Swabs
Why is blood gas relevant in sepsis?
If ABG is acidotic, this is due to hypoperfusion, anaerobic respiration is taking place
What does raised lactate mean?
- Not direct marker of tissue perfusion
- Associated with adverse outcomes in septic shock
- Normalising lactate reduces risk of persistent organ dysfunction
What fluids are given?
Bolus of crystalloids
- Especially if lactate >2mmol/l
- 0.9% NaCL
- Start with 10-20ml/kg over 5-10 minutes
- Re-evaluate perfusion, BP, lactate
- Maximum of 40ml/kg
- Then PICU and inotropes
Maintenance fluids
Monitor input and output
What antibiotics are given at each age group?
CAG
< 1 month
- Ceftriaxon, Amoxicillin, Gentamicin
- Consider aciclovir
1-3 months
- Ceftriaxone, Amoxicillin
>3months
- Ceftriaxone
What is the aim of antimicrobials?
Cover most common organisms
Group A strep
Group B strep
Listeria monocytogenes
Eshchericia Coli
Pneumococcal
Meningococcal
Pseudomonas Aeuriginosa
Compare Warm and Cold shock
For treatment this is what should be considered not actual treatment
Warm shock vs cold shock treatment
Treat the same
Fluid boluses up to 40-60ml/kg then adrenaline
Compare septic shock and hypovolaemic shock
Septic
- Distributive
- Vasodilation with reduced systemic vascular resistance
- Myocardial dysfunction
Hypovolaemic
- Insufficient intravascular volume
- Fluid loss
- Increased systemic vascular resistance
