UC Combined Conference: A Discussion of Sepsis in Pediatrics Adam A. Vukovic, MD September 10, 2014 University of Cincinnati

The Table of ABC Trouble APATENTIN TROUBLEOBSTRUCTED BNORMALDISTRESSFAILUREARREST CNORMALDISTRESSFAILUREARREST PPV SHOCK compensateddecompensated

Sepsis, the Continuum SEPTIC SHOCK SEPTIC SHOCK SEVERE SEPSIS SEVERE SEPSIS SIRS

Pediatric Age Groups for Severe Sepsis Newborn0 days to 1 week Neonate1 week to 1 month Infant1 month to 1 year Toddler/Preschool2 to 5 years School-aged child6 to 12 years Adolescent/Young Adult13 to < 18 years Goldstein et al., Pediatr Crit Care Med, 2005

Age-specific Vital Signs and Labs* Age group Heart Rate (BPM)Resp RateWBC CountSBP TachycardiaBradycardiaBreath/minX 10 3 mmHg Newborn> 180< 100> 50> 34< 65 Neonate> 180< 100> 40> 19.5 or < 5< 75 Infant> 180< 90> 34> 17.5 or < 5< 100 Toddler> 140NA> 22> 15.5 or < 6< 94 School age> 130NA> 18> 13.5 or < 4.5< 105 Adolescent> 110NA> 14> 11 or < 4.5< 117 Goldstein et al., Pediatr Crit Care Med, 2005 *upper limit values are 95 th percentile; lower limit values are 5 th percentile

Defining SIRS ACCP and SCCM: “Nonspecific inflammatory process occurring in adults after trauma, infection, burns, pancreatitis and other diseases.” International Consensus Conference on Pediatric Sepsis: – Two of the following four (one must be abnormal temperature or WBC count) Fever or hypothermia Tachycardia or bradycardia in those < 1 yo Tachypnea or need for mechanical respiration Leukocytosis or leukopenia Bone et al., Crit Care Med, 1992; Goldstein et al., Pediatr Crit Care Med, 2005

Infection “A suspected or proven infection caused by any pathogen OR a clinical syndrome associated with a high probability of infection.” Bone et al., Crit Care Med, 1992; Goldstein et al., Pediatr Crit Care Med, 2005

Sepsis ICCPS: “SIRS in the presence of or as a result of suspected or proven infection.” Bone et al., Crit Care Med, 1992; Goldstein et al., Pediatr Crit Care Med, 2005

Severe Sepsis ICCPS: Sepsis plus one of the following: - cardiovascular organ dysfunction - acute respiratory distress syndrome OR - two or more other organ dysfunctions Goldstein et al., Pediatr Crit Care Med, 2005

Septic Shock Hypotension? ICCPS: “Sepsis in the presence of cardiovascular dysfunction.” Heart Rate ↑ Perfusion ↓ Think: Severe End Organ Dysfunction!