Continued...

Severe sepsis:
Sepsis plus one of the following: cardiovascular organ dysfunction OR acute respiratory distress syndrome OR two or more other organ dysfunctions. Organ dysfunctions are defined in Table 2.

Septic shock:
Sepsis and cardiovascular organ dysfunction as defined in Table 2. (Modifications from the adult definitions are highlighted in boldface. a See Table 1 for age-specific ranges for physiologic and laboratory variables; b core temperature must be measured by rectal, bladder, oral, or central catheter probe).

Table 1 Age specific vital signs and laboratory values:

Age group	Heart rate		Respiratory rate (breaths/ min)	Leukocyte count (x1000/ cum m)	Systolic BP
	Tachycardia	Brady cardia
0-1 week	>180	<100	>50	>34	<65
1wk-1month	>180	<100	>40	>19.5 or<5	<75
1mo-1year	>180	<90	>34	>17.5 or <5	<100
2-5 year	>140	NA	>22	>15.5 or <6	<94
6-12 years	>130	NA	>18	>13.5 or<4.5	<105
13-< 18 year	>110	NA	>14	>11 or <4.5	<117

* Lower values for heart rate, leukocyte count, SBP(systolic blood pressure) are for the 5 th percentile and upper values for heart rate, respiratory rate or leukocyte count for the 95th percentile

Table 2 Organ dysfunction criteria:

Cardiovascular dysfunction
Despite administration of isotonic intravenous fluid bolus > 40 mL/kg in 1 hr

• Decrease in BP (hypotension) < 5th percentile for age or systolic BP > 2 SD below normal for age a
  OR
  
  
• Need for vasoactive drug to maintain BP in normal range (dopamine > 5 mcg/kg/min or dobutamine, epinephrine, or norepinephrine at
  any dose)
  OR
  
  
• Two of the following
  Unexplained metabolic acidosis: base deficit > 5.0 mEq/L Increased arterial lactate >2 times upper limit of normal
  Oliguria: urine output < 0.5 mL/kg/hr Prolonged capillary refill: >5 secs Core to peripheral temperature gap >3°C
  

Respiratory b

• PaO2/FIO2 < 300 in absence of cyanotic heart disease or pre-existing lung disease
  OR
  
  
• PaCO2 > 65 Torr or 20 mm Hg over baseline PaCO2
  OR
  
  
• Proven need c or >50% FIO2 to maintain saturation >92%
  OR
  
  
• Need for non-elective invasive or noninvasive mechanical ventilation d
  
  

Neurologic

• Glasgow Coma Score <11
  OR
  
  
• Acute change in mental status with a decrease in Glasgow Coma Score >3 points from abnormal baseline
  
  

Hematologic

• Platelet count: 80,000/mm3 or a decline of 50% in platelet count from highest value recorded over the past 3 days (for chronic
  hematology/oncology patients)
  OR
  
  
• International normalized ratio >2
  
  

Renal

• Serum creatinine >2 times upper limit of normal for age or 2-fold increase in baseline creatinine
  
  

Hepatic

• Total bilirubin >4 mg/dL (not applicable for newborn)
  OR
  
  
• ALT 2 times upper limit of normal for age (BP, blood pressure; ALT, alanine transaminase).
  
  

a See Table 1; b acute respiratory distress syndrome must include a PaO2/FIO2 ratio <200 mm Hg, bilateral infiltrates, acute onset, and no evidence of left heart failure . Acute lung injury is defined identically except the PaO2/FIO2 ratio must be <300 mm Hg; c proven need assumes oxygen requirement was tested by decreasing flow with subsequent increase in flow if required; d in postoperative patients, this requirement can be met if the patient has developed an acute inflammatory or infectious process in the lungs that prevents him or her from being extubated.)

The detection of altered organ function in the acutely ill patient constitutes multiple organ dysfunction syndrome (two or more organ involvement). The terminology dysfunction identifies this process as a phenomenon in which organ function is not capable of maintaining homeostasis. This process, which may be absolute or relative, can be more readily identified as a continuum of change over time.