1. Assessment of adherence to the 2020 Surviving Sepsis Campaign guidelines for fluid resuscitation in children with suspected septic shock in paediatric emergency departments: a prospective multicentre study.
- Author
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San Geroteo J, Levy M, Bailhache M, De Jorna C, Privat E, Gasmi O, Fuentes-Lopez M, Laoudi Y, Mazeghrane M, Malterre A, Bories P, Abdel Aal K, Arjoca I, Gaschignard J, Tanchaleune D, Minodier P, Audren F, Mazetier T, Quagliaro P, Raimond F, Sieng S, Robert B, Wohrer D, De Suremain N, and Dauger S
- Subjects
- Humans, Prospective Studies, Child, Preschool, Male, Female, Infant, Child, France, Practice Guidelines as Topic, Crystalloid Solutions administration & dosage, Crystalloid Solutions therapeutic use, Practice Patterns, Physicians' statistics & numerical data, Practice Patterns, Physicians' standards, Guideline Adherence statistics & numerical data, Fluid Therapy methods, Fluid Therapy standards, Shock, Septic therapy, Emergency Service, Hospital standards, Emergency Service, Hospital statistics & numerical data, Resuscitation standards, Resuscitation methods
- Abstract
Background: Paediatric sepsis is the leading cause of death in children under 5 years. No studies have evaluated the application of the Surviving Sepsis Campaign 2020 (SSC-2020) guidelines in paediatric emergency departments (PEDs)., Objective: To assess physician adherence to the SSC-2020 fluid resuscitation guidelines in children with suspected septic shock in PEDs., Methods: This was a prospective multicentre observational study conducted in 21 French hospitals over 5 sequential weeks, between November 2021 and March 2022. Children with suspected septic shock and who received antimicrobial therapy within 72 hours were included. Primary outcome was SSC-2020 fluid resuscitation guidelines adherence (low 0-24%; moderate 25-74%; high 75-100%) according to: bolus volume of 10-20 mL/kg each, exclusive administration of balanced crystalloids at 1 and 24 hours of management, and initiation of fluid resuscitation within 1 hour of septic shock recognition., Results: 63 children were included. 10 (16%) children had severe sepsis and 2 (3%) met the definition of septic shock. Compared with the SSC-2020 guidelines, 43 (68%) patients received boluses of 10-20 mL/kg; fluid resuscitation was initiated within 1 hour of septic shock recognition in 42 (76%) cases; balanced crystalloids were the only fluids administrated in 35 (56%) and 34 (55%) children at 1 and 24 hours of management, respectively. Main barriers reported by physicians were difficult intravenous access (43%), lack of team training (29%), workload constraints (28%), and absence or out-of-date protocols (24%)., Conclusions: This study found high adherence for fluid resuscitation initiation but moderate adherence for bolus volume and fluid choice., Trial Registration Number: NCT05066464., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2024
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