Epidemiology of Pediatric Severe Sepsis in Main PICU Centers in Southwest China*
Changxue XiaoSa WangFang FangFeng XuShufang XiaoBin LiGuoying ZhangXiaoli LuoJiang Jian-yuBo HuangYu ChenJianli ChenHuazhu WangJing YuDan RenXiaoling RenChenxi Tang
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Objectives: To estimate the prevalence, management, and outcomes of pediatric severe sepsis in the main PICUs in Southwest China. Design: A prospective, observational, and multicenter study. Setting: Eight PICUs in Southwest China with 19 (13–24) beds and 1,322 (1,066–1,452) annual admissions each. Patients: A total of 10,598 patients (29 d to 18 yr old) were consecutively admitted between September 1, 2016, and August 31, 2017. All patients were screened and evaluated for severe sepsis or septic shock. Of them, 10,353 patients were excluded due to incomplete data or not meeting the consensus criteria for severe sepsis or septic shock; 245 patients were included with complete data. Interventions: None. Measurements and Main Results: Finally, 245 patients who were diagnosed with severe sepsis or septic shock were included in the study, with an incidence rate of 2.3%. Of them, 64.0% of the enrolled patients were male with 80.8% being less than 5 years old and 60.8% being from rural areas. The respiratory system was the most common organ system in which dysfunction was observed (76.7%) as well as the most frequently infected site (37.6%). The primary therapies were antibiotics (99.0%), immunoglobulin (88.3%), mechanical ventilation (78.4%), vasoactive infusions (59.6%), and corticosteroids (46.1%). Among the 188 patients who had respiratory dysfunction, 173(92%) required mechanical ventilation and 39 (20.7%) met the criteria for pediatric acute respiratory distress syndrome. Seven of the patients with pediatric acute respiratory distress syndrome died (7/39, 17.9%). The median durations for mechanical ventilation and vasoactive medications were 123.5 hours (35.25–226.00 hr) and 2 days (1–5 d), respectively. Eighty-six percent of patients had multiple organ dysfunction syndrome at the point at which severe sepsis was recognized, and 31% had underlying conditions. The hospital mortality rate was 18.8%. Conclusions: This report is the first to present the prevalence, treatment, and outcomes of pediatric severe sepsis in the main PICU centers in Southwest China. The mortality rate remains high; therefore, improved clinical management and implementation of large-scale clinical trials are necessary to improve early diagnoses and treatment.Keywords:
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Procalcitonin (PCT) is a valuable prognostic biomarker in human sepsis that is predictive of organ dysfunction, septic shock and mortality. Data on PCT in dogs is limited. This study aimed to investigate the prognostic value of baseline and serial PCT measurements in dogs with sepsis and to determine the association between PCT and sepsis severity and the presence of organ dysfunction. PCT concentrations were measured in citrated plasma samples collected from 53 dogs with sepsis at the time of admission (T0, n = 53) and at 24 h (T1, n = 35) and 48 h (T2, n = 30) post-admission using a commercial ELISA. Dogs were classified by sepsis severity (sepsis without organ dysfunction; severe sepsis; septic shock) and outcome (survivors; non-survivors). Organ dysfunctions were recorded at T0 and during hospitalization, and the APPLEfast score calculated at T0. Healthy dogs (n = 12) were used as controls.There were 18 septic dogs without organ dysfunction, 24 dogs with severe sepsis and 11 with septic shock. Baseline PCT concentrations were significantly greater in dogs with sepsis compared to healthy controls (P < 0.0001), and in dogs with septic shock compared to dogs without cardiovascular compromise (P = 0.01). Baseline PCT was significantly correlated with organ dysfunction (P = 0.003). Declining PCT concentrations were documented in survivors at T1 and T2 compared to PCT at T0 (P = 0.0006), and PCT clearance at 24 h was significantly higher in survivors (n = 38) compared to non-survivors (n = 15) (P = 0.037). Canine APPLEfast score was not predictive of sepsis severity, the development of MODS or outcome.In dogs with sepsis, PCT concentrations at hospital admissions are predictive of organ dysfunction and septic shock. Serial procalcitonin monitoring may offer valuable prognostic information in canine sepsis, wherein early decreases in PCT concentrations are associated with survival.
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Sepsis is the main cause of close to 70% of all cases of acute respiratory distress syndromes (ARDS). In addition, sepsis increases susceptibility to ventilator-induced lung injury. Therefore, the development of a ventilatory strategy that can achieve adequate oxygenation without injuring the lungs is highly sought after for patients with acute infection and represents an important therapeutic window to improve patient care. Suboptimal ventilatory settings cannot only harm the lung, but may also contribute to the cascade of organ failure in sepsis due to organ crosstalk.Despite the prominent role of sepsis as a cause for lung injury, most of the studies that addressed mechanical ventilation strategies in ARDS did not specifically assess sepsis-related ARDS patients. Consequently, most of the recommendations regarding mechanical ventilation in sepsis patients are derived from ARDS trials that included multiple clinical diagnoses. While there have been important improvements in general ventilatory management that should apply to all critically ill patients, sepsis-related lung injury might still have particularities that could influence bedside management.After revisiting the interplay between sepsis and ventilation-induced lung injury, this review will reappraise the evidence for the major components of the lung protective ventilation strategy, emphasizing the particularities of sepsis-related acute lung injury.
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In February 2020, "surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children" was published in Intensive Care Medicine and Pediatric Critical Care Medicine. This article gives an interpretation on the guidelines to help Chinese pediatricians better understand it.
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Significant biventricular cardiac dysfunction occurs early in sepsis and multiple organ dysfunction syndrome. Multiple mediators and physiologic derangements result in the characteristic hemodynamic alterations associated with sepsis. The ability of the myocardium to compensate for this failure and continue to generate adequate flow to meet tissue oxygen needs defines the difference between survivors and nonsurvivors of sepsis and multiple organ dysfunction syndrome. This article discusses the physiologic and hemodynamic differences between survivors and nonsurvivors of sepsis and describes key monitoring techniques that guide interventions.
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Objective To investigate the general data,laboratory parameters,disease severity,clinical behavior,and prognosis in sepsis-induced and non-sepsis-induced ARDS patients.Methods 161patients treated in Chinese PLA general hospital from January 2000 to June 2012 were enrolled into our study according to the 2011 Berlin Definition of Acute respiratory distress syndrome.They were divided into sepsis-induced and non-sepsis induced ARDS due to their etiology,and their diversity was compared.Results Among these 180 patients selected,19 patients who refused treatment were excluded from statistics,and 161 cases were finally brought into analysis.The sepsis-induced ARDS was 120 cases (74.5％) and the main cause was pulmonary infection (82.5％).Within the 24 hours of ARDS diagnosis,septic patients had obvious lower serum creatinine and total bilirubin levels.Among the other indicators,including PaO2/FiO2 ratio,APACHE Ⅱ score,SOFA,lung injury scores (LIS),and multiple organ dysfunction,no statistics distinction was observed.The invasive mechanical ventilation days in non-sepsis related group was longer than that in septic group (median,ten days vs six days,P =0.008),there was no statistical significance in hospital mortality and mechanical ventilation days in survivors.There was statistical significance in the hospital mortality,28-day mortality,oxygenation index,LIS,and SOFA scores among mild,moderate,and severe levels of ARDS.In moderate level of ARDS,BMI,PaO2/FiO2ratio,and invasive mechanical ventilation days were lower and APACHE Ⅱ score was higher in septic group than those in non-sepsis-induced group.And there was no statistical significance in mortality rate between two groups among all levels.Conclusions Sepsis is the main reason of ARDS,which owns less invasive mechanical ventilation days and no difference with non-sepsis in mortality and disease severity.Stage of mild,moderate,and severe ARDS is associated with increased mortality and visible discrepancy of disease severity.
Key words:
Acute respiratory distress syndrome; Acute lung injury; Sepsis
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