Abstract | BACKGROUND: The Institute of Medicine has called for the development of clinical guidelines and practice parameters to develop "best practice" and potentially improve patient outcome. OBJECTIVE: To provide American College of Critical Care Medicine clinical guidelines for hemodynamic support of neonates and children with septic shock. SETTING: Individual members of the Society of Critical Care Medicine with special interest in neonatal and pediatric septic shock were identified from literature review and general solicitation at Society of Critical Care Medicine Educational and Scientific Symposia (1998-2001). METHODS: RESULTS: Only four randomized controlled trials in children with septic shock could be identified. None of these randomized trials led to a change in practice. Clinical practice has been based, for the most part, on physiologic experiments, case series, and cohort studies. Despite relatively low American College of Critical Care Medicine-graded evidence in the pediatric literature, outcomes in children have improved from 97% mortality in the 1960s to 60% in the 1980s and 9% mortality in 1999. U.S. hospital survival was three-fold better in children compared with adults (9% vs. 27% mortality) in 1999. Shock pathophysiology and response to therapies is age specific. For example, cardiac failure is a predominant cause of death in neonates and children, but vascular failure is a predominant cause of death in adults. Inotropes, vasodilators (children), inhaled nitric oxide (neonates), and extracorporeal membrane oxygenation can be more important contributors to survival in the pediatric populations, whereas vasopressors can be more important contributors to adult survival. CONCLUSION: American College of Critical Care Medicine adult guidelines for hemodynamic support of septic shock have little application to the management of pediatric or neonatal septic shock. Studies are required to determine whether American College of Critical Care Medicine guidelines for hemodynamic support of pediatric and neonatal septic shock will be implemented and associated with improved outcome.
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Authors | Joseph A Carcillo, Alan I Fields, American College of Critical Care Medicine Task Force Committee Members |
Journal | Critical care medicine
(Crit Care Med)
Vol. 30
Issue 6
Pg. 1365-78
(Jun 2002)
ISSN: 0090-3493 [Print] United States |
PMID | 12072696
(Publication Type: Journal Article, Review)
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Chemical References |
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Topics |
- Child
- Critical Care
- Evidence-Based Medicine
- Extracorporeal Membrane Oxygenation
- Fluid Therapy
- Hemodynamics
- Humans
- Infant, Newborn
- Pediatrics
- Resuscitation
(methods)
- Shock, Septic
(diagnosis, physiopathology, therapy)
- Societies, Medical
- United States
- Vasodilator Agents
(therapeutic use)
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