Keterangan
Pediatric sepsis is a life-threatening condition caused by the body’s extreme response to infection, and early recognition is critical for successful management. The first signs often include fever, tachycardia, respiratory distress, altered mental status, or decreased urine output, though these may be subtle in young children. Immediate assessment using pediatric early warning systems (PEWS) can help identify sepsis at its earliest stage. Once sepsis is suspected, rapid intervention is crucial. Initial management focuses on stabilizing the airway, breathing, and circulation, followed by early administration of intravenous fluids to combat shock. Broad-spectrum antibiotics should be administered within the first hour of diagnosis to target the underlying infection. Ongoing monitoring of vital signs, blood lactate levels, and urine output helps assess the effectiveness of interventions. Delayed recognition or treatment increases the risk of multi-organ failure and death, highlighting the importance of swift, aggressive management to improve outcomes in pediatric sepsis.
Ringkasan
- Shock is a life-threatening condition characterized by inadequate tissue perfusion leading to decreased oxygen and nutrient delivery. There are four primary types: hypovolemic, distributive, cardiogenic, and obstructive, each with distinct effects on preload, afterload, and contractility. Globally, pediatric sepsis affects millions and results in millions of deaths annually, highlighting the critical need for understanding and timely management.
- Sepsis is a life-threatening syndrome caused by a severe infection and a dysregulated host response, leading to tissue injury and microcirculatory dysfunction. Pediatric sepsis definitions have evolved, with the 2024 guidelines using the Phoenix score to assess organ dysfunction across respiratory, cardiac, neurological, and coagulation systems. Septic shock is defined as sepsis with at least one cardiovascular dysfunction.
- Recognizing shock involves clinical monitoring of perfusion parameters like heart rate, capillary refill time (CRT), and temperature differentials. End-organ perfusion can be assessed by monitoring mentation and urine output. Blood gas analysis reveals metabolic acidosis, elevated lactate, and decreased venous oxygen saturation.
- Fluid resuscitation is now approached cautiously, using 10 ml/kg boluses with careful assessment for fluid responsiveness to avoid over-resuscitation. IVC collapsibility can be assessed via ultrasound to determine fluid responsiveness. Inotropic and vasopressor support should be considered earlier than previously recommended.
- The choice between vasopressors and inotropes depends on the type of shock. The concept of "warm" vs. "cold" shock has evolved, recognizing that most shock states involve a vasodilatory component. Echo is used to assess contractility. Noradrenaline is generally initiated first, with adrenaline or dobutamine added for compromised contractility.
- Antibiotics should be administered early, focusing on broad-spectrum coverage and considering local resistance patterns. Ongoing assessment of upstream parameters (heart rate, BP) and downstream parameters (lactate, urine output, venous oxygen saturation) is crucial. Ventilation is critical for vasopressor-resistant shock. Refractory shock may require steroids.
- De-escalation of inotropes and vasopressors must be done gradually with careful monitoring. Early nutritional support should be initiated once the shock component improves. Vaccines play a crucial role in reducing the risk of sepsis by preventing infections. Long-term follow-up is essential to monitor for potential sequelae like neuromuscular weakness or organ dysfunction.
Contoh Sertifikat
Tentang Pembicara
Dr. Abhijit Bagde
Konsultan Dokter Spesialis Anak & Kepala, Dokter Spesialis Rawat Intensif Anak, Apollo Hospitals, Navi Mumbai
Pengungkapan Keuangan
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