Introduction :

Surviving sepsis campaign guidelines for management of severe sepsis In children : In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for other supportive therapies in sepsis that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and to improve outcome in severe sepsis (1). The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. Pediatric representatives attended the various section meetings and workshops to contrast adult and pediatric management. Surviving sepsis campaign guidelines are now published for adults (1) with pediatric considerations (2) as a small section based on the available evidence. Guidelines of hemodynamic support for pediatrics are also published (3). Practical application of this information in Indian set up in a child with septic shock will be discussed. In 1992 ACCP/SCCM consensus guidelines for definitions of sepsis were published by Bone et al (4). Definitions have also been recently revised for pediatrics recently as follows (5).

Definitions (5)

Hypovolemia is the most common cause of pediatric shock. Septic shock is the prototype combination of hypovolemia, cardiogenic and distributive shock. Following are the latest definitions published in 2005, related to sepsis and septic shock.

SIRS (a) (systemic inflammatory response syndrome)

The presence of at least two of the following four criteria, one of which must be abnormal temperature or leukocyte count:

• Core ( b) temperature of >38.5°C or < 36°C.
  
  
• Tachycardia, defined as a mean heart rate >2 SD above normal for age in the absence of external stimulus, chronic drugs, or painful stimuli; or otherwise unexplained persistent elevation over a 0.5- to 4-hr time period OR for children < 1 yr old: bradycardia, defined as a mean heart rate < 10th percentile for age in the absence of external vagal stimulus, beta-blocker drugs, or congenital heart disease; or otherwise unexplained persistent depression over a 0.5-hr time period.
  
  
• Mean respiratory rate >2 SD above normal for age or mechanical ventilation for an acute process not related to underlying neuromuscular disease or the receipt of general anesthesia.
  
  
• Leukocyte count elevated or depressed for age (not secondary to chemotherapy-induced leukopenia) or > 10% immature neutrophils.

Infection:

A suspected or proven (by positive culture, tissue stain, or polymerase chain reaction test) infection caused by any pathogen OR a clinical syndrome associated with a high probability of infection. Evidence of infection includes positive findings on clinical exam, imaging, or laboratory tests (e.g., white blood cells in a normally sterile body fluid, perforated viscus, chest radiograph consistent with pneumonia, petechial or purpuric rash, or purpura fulminans).

Sepsis:

SIRS in the presence of or as a result of suspected or proven infection.