1. Pediatric Sepsis Dr. Indumathy Santhanam MD,DCH Professor and Head,
Paediatric Emergency Department
Institute of Child Health & Hospital for Children,
Madras Medical College-India

2. Definition of sepsis Life threatening organ dysfunction
Dysregulated host response
Infection

3. Sepsis-induced organ dysfunction may be occult
Its presence should be considered in any patient presenting with infection
Unrecognized infection may be the cause of new-onset organ dysfunction.
? Possibility of underlying infection

4. Criteria to recognise sepsis
“Organ dysfunction: Increase “Sequential [Sepsis-related] Organ Failure Assessment” (SOFA) score of 2 points or more
Associated with a mortality of 10%!
M. Singer, C.S. Deutschman, C. W. Seymour, Third International Consensus Definition for Sepsis and septic shock JAMA. 2016;315(8): doi: /jama

5. Sepsis Organ Failure Assessment

6. Poor outcome more likely if qSOFA was 2:
Respiratory rate of 22/min or greater,
Altered mentation
Systolic BP: 100 mm Hg or less
M. Singer, C.S. Deutschman, C. W. Seymour, Third International Consensus Definition for Sepsis and septic shock JAMA. 2016;315(8): doi: /jama

7. Septic shock
Vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater
Serum lactate level > 2 mmol/L (>18 mg/dL) in the absence of hypovolemia.
Associated with a mortality of 40%
M. Singer, C.S. Deutschman, C. W. Seymour, Third International Consensus Definition for Sepsis and septic shock JAMA. 2016;315(8): doi: /jama

8. How do we recognize sepsis in busy OPDs where fever is the commonest cause for hospital visits?

9. Is it infection or sepsis?
Sepsis: Dysregulated host response + organ dysfunction

10. Applicability Lab investigations in OPDs for suspected sepsis:
Blood collection not easy in sick kids
Often unavailable in OPD settings
Take time
Cost

11. How we recognize sepsis in our setting…
Triage questions for all children who present with fever/foci
Busy OPDs!
1) History of incessant cry, lethargy, more sleepy than usual, ‘not as usual’.
If yes, anticipate shock
2) History of breathlessness?
(not episodic or since birth)
If yes, anticipate pulmonary oedema due to ALI or cardiac dysfunction.
Pediatric Emergency Medicine Course-2013

12. Clinical criteria to recognize sepsis
Modified Rapid cardio-pulmonary cerebral assessment and modified PAT
Pediatric Emergency Medicine Course-2013

13. Concurrently resuscitate using the same tool
Pediatric Emergency Medicine Course-2013

14. Management of septic shock based on a prospective randomized controlled trial since 2004!

16. Mortality due to septic shock 2005 and 2014
Septic shock: Mortality :55.9% 2005 vs 5.2% in 2014: OR ( 95 CI : P<0.000 )
Data from MRD,ICH&HC, Chennai

17. Ideal clinical criteria
Triage questions
Modified rapid cardiopulmonary cerebral assessment
Modified PAT aid in early recognition
Concurrent management
Identify all the elements of sepsis (infection, host response, and organ dysfunction)
Simple to obtain
Prompt availability
Reasonable cost or burden.

18. Summary
The criteria for recognizing sepsis in our centre needs validation