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Septic shock occurs when an infection enters the blood stream and toxic substances (endotoxins) are released by dying bacteria. Part of the recommended treatment of sepsis includes aggressive fluid resuscitation, which means the infusion of large amounts of fluid over rather short periods. Although this approach is effective in adults, its effects in children have not been studied extensively. To learn more about this issue, the outcomes of 34 pediatric sepsis cases (median age, 13.5 months) were compared according to the amount of fluid administered. The criteria for diagnosing sepsis are presented. Patients who received the greatest volume of fluid after arrival in the emergency department were more likely to survive than those who received less. There was only one death among the nine patients who received the maximum dose, compared with 15 deaths among the 25 patients in the other two groups. Survivors received more fluid than nonsurvivors at one hour but similar quantities at six hours. Rapid fluid resuscitation with volumes in excess of 40 milliliters per kilogram in the first hour after the patient arrives in the emergency department led to the best outcome. Until recently, treatment of pediatric shock called for fluid administration of 10 to 20 milliliters per kilogram, but improvements in treating sepsis make it possible to infuse more fluid. No increase in complications was noted with this more aggressive approach. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objectives: The American College of Critical Care Medicine provided 2002 and 2007 guidelines for hemodynamic support of newborn and pediatric septic shock. Provide the 2014 update of the 2007 American College of Critical Care Medicine "Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock."Design: Society of Critical Care Medicine members were identified from general solicitation at Society of Critical Care Medicine Educational and Scientific Symposia (2006-2014). The PubMed/Medline/Embase literature (2006-14) was searched by the Society of Critical Care Medicine librarian using the keywords: sepsis, septicemia, septic shock, endotoxemia, persistent pulmonary hypertension, nitric oxide, extracorporeal membrane oxygenation, and American College of Critical Care Medicine guidelines in the newborn and pediatric age groups.Measurements and Main Results: The 2002 and 2007 guidelines were widely disseminated, translated into Spanish and Portuguese, and incorporated into Society of Critical Care Medicine and American Heart Association/Pediatric Advanced Life Support sanctioned recommendations. The review of new literature highlights two tertiary pediatric centers that implemented quality improvement initiatives to improve early septic shock recognition and first-hour compliance to these guidelines. Improved compliance reduced hospital mortality from 4% to 2%. Analysis of Global Sepsis Initiative data in resource rich developed and developing nations further showed improved hospital mortality with compliance to first-hour and stabilization guideline recommendations.Conclusions: The major new recommendation in the 2014 update is consideration of institution-specific use of 1) a "recognition bundle" containing a trigger tool for rapid identification of patients with septic shock, 2) a "resuscitation and stabilization bundle" to help adherence to best practice principles, and 3) a "performance bundle" to identify and overcome perceived barriers to the pursuit of best practice principles. [ABSTRACT FROM AUTHOR]