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Watson RS, Carrol ED, Carter MJ, Kissoon N, Ranjit S, Schlapbach LJ. The burden and contemporary epidemiology of sepsis in children. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:670-681. [PMID: 39142741 DOI: 10.1016/s2352-4642(24)00140-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 05/27/2024] [Accepted: 06/04/2024] [Indexed: 08/16/2024]
Abstract
Sepsis is a dysregulated host response to infection that leads to life-threatening organ dysfunction. Half of the 50 million people affected by sepsis globally every year are neonates and children younger than 19 years. This burden on the paediatric population translates into a disproportionate impact on global child health in terms of years of life lost, morbidity, and lost opportunities for children to reach their developmental potential. This Series on paediatric sepsis presents the current state of diagnosis and treatment of sepsis in children, and maps the challenges in alleviating the burden on children, their families, and society. Drawing on diverse experience and multidisciplinary expertise, we offer a roadmap to improving outcomes for children with sepsis. This first paper of the Series is a narrative review of the burden of paediatric sepsis from low-income to high-income settings. Advances towards improved operationalisation of paediatric sepsis across all age groups have facilitated more standardised assessment of the Global Burden of Disease estimates of the impact of sepsis on child health, and these estimates are expected to gain further precision with the roll out of the new Phoenix criteria for sepsis. Sepsis remains one of the leading causes of childhood morbidity and mortality, with immense direct and indirect societal costs. Although substantial regional differences persist in relation to incidence, microbiological epidemiology, and outcomes, these cannot be explained by differences in income level alone. Recent insights into post-discharge sequelae after paediatric sepsis, ranging from late mortality and persistent neurodevelopmental impairment to reduced health-related quality of life, show how common post-sepsis syndrome is in children. Targeting sepsis as a key contributor to poor health outcomes in children is therefore an essential component of efforts to meet the Sustainable Development Goals.
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Affiliation(s)
- R Scott Watson
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Enitan D Carrol
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool Institute of Infection, Veterinary and Ecological Sciences, Liverpool, UK
| | - Michael J Carter
- Centre for Human Genetics, University of Oxford, Oxford, UK; Paediatric Intensive Care unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Niranjan Kissoon
- Global Child Health Department of Pediatrics and Emergency Medicine, British Columbia Women and Children's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | | | - Luregn J Schlapbach
- Department of Intensive Care and Neonatology and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.
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Qin Y, Caldino Bohn RI, Sriram A, Kernan KF, Carcillo JA, Kim S, Park HJ. Refining empiric subgroups of pediatric sepsis using machine-learning techniques on observational data. Front Pediatr 2023; 11:1035576. [PMID: 36793336 PMCID: PMC9923004 DOI: 10.3389/fped.2023.1035576] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/05/2023] [Indexed: 01/31/2023] Open
Abstract
Sepsis contributes to 1 of every 5 deaths globally with 3 million per year occurring in children. To improve clinical outcomes in pediatric sepsis, it is critical to avoid "one-size-fits-all" approaches and to employ a precision medicine approach. To advance a precision medicine approach to pediatric sepsis treatments, this review provides a summary of two phenotyping strategies, empiric and machine-learning-based phenotyping based on multifaceted data underlying the complex pediatric sepsis pathobiology. Although empiric and machine-learning-based phenotypes help clinicians accelerate the diagnosis and treatments, neither empiric nor machine-learning-based phenotypes fully encapsulate all aspects of pediatric sepsis heterogeneity. To facilitate accurate delineations of pediatric sepsis phenotypes for precision medicine approach, methodological steps and challenges are further highlighted.
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Affiliation(s)
- Yidi Qin
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rebecca I. Caldino Bohn
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Aditya Sriram
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kate F. Kernan
- Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Joseph A. Carcillo
- Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Soyeon Kim
- Division of Pediatric Pulmonary Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Hyun Jung Park
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
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3
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Fustiñana A, Yock-Corrales A, Casson N, Galvis L, Iramain R, Lago P, Da Silva APP, Paredes F, Zamarbide MP, Aprea V, Kohn-Loncarica G. Adherence to Pediatric Sepsis Treatment Recommendations at Emergency Departments: A Multicenter Study in Latin America. Pediatr Emerg Care 2022; 38:e1496-e1502. [PMID: 35802481 DOI: 10.1097/pec.0000000000002801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Sepsis is one of the most urgent health care issues worldwide. Guidelines for early identification and treatment are essential to decrease sepsis-related mortality. Our aim was to collect data on the epidemiology of pediatric septic shock (PSS) from the emergency department (PED) and to assess adherence to recommendations for its management in the first hour. METHODS A multicenter, prospective, cross-sectional study was conducted evaluating children with PSS seen at the PED of 10 tertiary-care centers in Latin America. Adherence to guidelines was evaluated. RESULTS We included 219 patients (median age, 3.7 years); 43% had comorbidities, 31% risk factors for developing sepsis, 74% clinical signs of "cold shock," and 13% of "warm shock," 22% had hypotension on admission. Consciousness was impaired in 55%. A peripheral line was used as initial access in 78% (median placement time, 10 minutes). Fluid and antibiotics infusion was achieved within a median time of 30 minutes (interquartile range [IQR], 20-60 minutes) and 40 minutes (IQR, 20-60 minutes), respectively; 40% responded inadequately to fluids requiring vasoactive drugs (median time at initiation, 60 minutes; IQR, 30-135 minutes). Delay to vasoactive drug infusion was significantly longer when a central line was placed compared to a peripheral line (median time, 133 minutes [59-278 minutes] vs 42 minutes [30-70 minutes], respectively [ P < 0.001]). Adherence to all treatment goals was achieved in 13%. Mortality was 10%. An association between mortality and hypotension on admission was found (26.1% with hypotension vs 4.9% without; P < 0.001). CONCLUSIONS We found poor adherence to the international recommendations for the treatment of PSS in the first hour at the PED in third-level hospitals in Latin America.
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Kohn-Loncarica G, Hualde G, Fustiñana A, Monticelli MF, Reinoso G, Cortéz M, Segovia L, Mareco-Naccarato G, Rino P. Use of Inotropics by Peripheral Vascular Line in the First Hour of Treatment of Pediatric Septic Shock: Experience at an Emergency Department. Pediatr Emerg Care 2022; 38:e371-e377. [PMID: 33214518 DOI: 10.1097/pec.0000000000002295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Mortality in pediatric septic shock remains unacceptably high. Delays in vasopressor administration have been associated with an increased risk of mortality. Current treatment guidelines suggest the use of a peripheral vascular line (PVL) for inotropic administration in fluid-refractory septic shock when a central vascular line is not already in place. The aim of this study was to report local adverse effects associated with inotropic drug administration through a PVL at a pediatric emergency department setting in the first hour of treatment of septic shock. METHODS A prospective, descriptive, observational cohort study of patients with septic shock requiring PVL inotropic administration was conducted at the pediatric emergency department of a tertiary care pediatric hospital. For the infusion and postplacement care of the PVL for vasoactive drugs, an institutional nursing protocol was used. RESULTS We included 49 patients; 51% had an underlying disease. Eighty-four percent of the children included had a clinical "cold shock." The most frequently used vasoactive drug was epinephrine (72%). One patient presented with local complications. CONCLUSIONS At our center, infusion of vasoactive drugs through a PVL was shown to be safe and allowed for adherence to the current guidelines for pediatric septic shock.
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de Souza DC, Gonçalves Martin J, Soares Lanziotti V, de Oliveira CF, Tonial C, de Carvalho WB, Roberto Fioretto J, Pedro Piva J, Juan Troster E, Siqueira Bossa A, Gregorini F, Ferreira J, Lubarino J, Biasi Cavalcanti A, Ribeiro Machado F. The epidemiology of sepsis in paediatric intensive care units in Brazil (the Sepsis PREvalence Assessment Database in Pediatric population, SPREAD PED): an observational study. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:873-881. [PMID: 34756191 DOI: 10.1016/s2352-4642(21)00286-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Data on the prevalence and mortality of paediatric sepsis in resource-poor settings are scarce. We aimed to assess the prevalence and in-hospital mortality of severe sepsis and septic shock treated in paediatric intensive care units (PICUs) in Brazil, and risk factors for mortality. METHODS We performed a nationwide, 1-day, prospective point prevalence study with follow-up of patients with severe sepsis and septic shock, using a stratified random sample of all PICUs in Brazil. Patients were enrolled at each participating PICU on a single day between March 25 and 29, 2019. All patients occupying a bed at the PICU on the study day (either admitted previously or on that day) were included if they were aged 28 days to 18 years and met the criteria for severe sepsis or septic shock at any time during hospitalisation. Patients were followed up until hospital discharge or death, censored at 60 days. Risk factors for mortality were assessed using a Poisson regression model. We used prevalence to generate national estimates. FINDINGS Of 241 PICUs invited to participate, 144 PICUs (capacity of 1242 beds) included patients in the study. On the day of the study, 1122 children were admitted to the participating PICUs, of whom 280 met the criteria for severe sepsis or septic shock during hospitalisation, resulting in a prevalence of 25·0% (95% CI 21·6-28·8), with a mortality rate of 19·8% (15·4-25·2; 50 of 252 patients with complete clinical data). Increased risk of mortality was associated with higher Pediatric Sequential Organ Failure Assessment score (relative risk per point increase 1·21, 95% CI 1·14-1·29, p<0·0001), unknown vaccination status (2·57, 1·26-5·24; p=0·011), incomplete vaccination status (2·16, 1·19-3·92; p=0·012), health care-associated infection (2·12, 1·23-3·64, p=0·0073), and compliance with antibiotics (2·38, 1·46-3·86, p=0·0007). The estimated incidence of PICU-treated sepsis was 74·6 cases per 100 000 paediatric population (95% CI 61·5-90·5), which translates to 42 374 cases per year (34 940-51 443) in Brazil, with an estimated mortality of 8305 (6848-10 083). INTERPRETATION In this representative sample of PICUs in a middle-income country, the prevalences of severe sepsis or septic shock and in-hospital mortality were high. Modifiable factors, such as incomplete vaccination and health care-associated infections, were associated with greater risk of in-hospital mortality. FUNDING Fundação de Amparo à Pesquisa do Estado de São Paulo and Conselho Nacional de Desenvolvimento Científico e Tecnológico. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Daniela Carla de Souza
- Instituto Latino Americano de Sepsis, São Paulo, Brazil; Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil.
| | - Joelma Gonçalves Martin
- Department of Pediatrics, Medical School of Universidade Estadual Paulista-UNESP, Botucatu, Brazil
| | - Vanessa Soares Lanziotti
- Pediatric Intensive Care Unit & Research and Education Division/Maternal and Child Health Postgraduate Program, Universidade Federal do Rio de Janeiro, Rio de Janiero, Brazil
| | | | - Cristian Tonial
- Pediatric Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Werther Brunow de Carvalho
- Pediatric Intensive Care/Neonatology of the Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Roberto Fioretto
- Department of Pediatrics, Medical School of Universidade Estadual Paulista-UNESP, Botucatu, Brazil
| | - Jefferson Pedro Piva
- Pediatric Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Eduardo Juan Troster
- Medical School of Faculdade Israelita Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | - Flávia Ribeiro Machado
- Instituto Latino Americano de Sepsis, São Paulo, Brazil; Anesthesiology, Pain and Intensive Care Department, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
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Kohn-Loncarica GA, Fustiñana AL, Jabornisky RM, Pavlicich SV, Prego-Pettit J, Yock-Corrales A, Luna-Muñoz CR, Casson NA, Álvarez-Gálvez EA, Zambrano IR, Contreras-Núñez C, Santos CM, Paniagua-Lantelli G, Gutiérrez CE, Amantea SL, González-Dambrauskas S, Sánchez MJ, Rino PB, Mintegi S, Kissoon N. How Are Clinicians Treating Children With Sepsis in Emergency Departments in Latin America?: An International Multicenter Survey. Pediatr Emerg Care 2021; 37:e757-e763. [PMID: 31058761 DOI: 10.1097/pec.0000000000001838] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Guidelines adherence in emergency departments (EDs) relies partly on the availability of resources to improve sepsis care and outcomes. Our objective was to assess the management of pediatric septic shock (PSS) in Latin America's EDs and to determine the impact of treatment coordinated by a pediatric emergency specialist (PEMS) versus nonpediatric emergency specialists (NPEMS) on guidelines adherence. METHODS Prospective, descriptive, and multicenter study using an electronic survey administered to PEMS and NPEMS who treat PSS in EDs in 14 Latin American countries. RESULTS We distributed 2164 surveys with a response rate of 41.5%, of which 22.5% were PEMS. Overall American College of Critical Care Medicine reported guidelines adherence was as follows: vascular access obtained in 5 minutes, 76%; fluid infusion technique, 60%; administering 40 to 60 mL/kg within 30 minutes, 32%; inotropic infusion by peripheral route, 61%; dopamine or epinephrine in cold shock, 80%; norepinephrine in warm shock, 57%; and antibiotics within 60 minutes, 82%. Between PEMS and NPEMS, the following differences were found: vascular access in 5 minutes, 87.1% versus 72.7% (P < 0.01); fluid infusion technique, 72.3% versus 55.9% (P < 0.01); administering 40 to 60 mL/kg within 30 minutes, 42% versus 29% (P < 0.01); inotropic infusion by peripheral route, 75.7% versus 56.3% (P < 0.01); dopamine or epinephrine in cold shock, 87.1% versus 77.3% (P < 0.05); norepinephrine in warm shock, 67.8% versus 54% (P < 0.01); and antibiotic administration within first 60 minutes, 90.1% versus 79.3% (P < 0.01), respectively. Good adherence criteria were followed by 24%. The main referred barrier for sepsis care was a failure in its recognition, including the lack of triage tools. CONCLUSIONS In some Latin American countries, there is variability in self-reported adherence to the evidence-based recommendations for the treatment of PSS during the first hour. The coordination by PEMS support greater adherence to these recommendations.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pedro B Rino
- Unidad Emergencias, Hospital de Pediatría Prof. Dr. Juan P. Garrahan y Universidad de Buenos Aires, Buenos Aires
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Souza DC, Barreira ER, Shieh HH, Ventura AMC, Bousso A, Troster EJ. Prevalence and outcomes of sepsis in children admitted to public and private hospitals in Latin America: a multicenter observational study. Rev Bras Ter Intensiva 2021; 33:231-242. [PMID: 34231803 PMCID: PMC8275081 DOI: 10.5935/0103-507x.20210030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/25/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To report the prevalence and outcomes of sepsis in children admitted to public and private hospitals. METHODS Post hoc analysis of the Latin American Pediatric Sepsis Study (LAPSES) data, a cohort study that analyzed the prevalence and outcomes of sepsis in critically ill children with sepsis on admission at 21 pediatric intensive care units in five Latin American countries. RESULTS Of the 464 sepsis patients, 369 (79.5%) were admitted to public hospitals and 95 (20.5%) to private hospitals. Compared to those admitted to private hospitals, sepsis patients admitted to public hospitals did not differ in age, sex, immunization status, hospital length of stay or type of admission but had higher rates of septic shock, higher Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality 2 (PIM 2), and Pediatric Logistic Organ Dysfunction (PELOD) scores, and higher rates of underlying diseases and maternal illiteracy. The proportion of patients admitted from pediatric wards and sepsis-related mortality were higher in public hospitals. Multivariate analysis did not show any correlation between mortality and the type of hospital, but mortality was associated with greater severity on pediatric intensive care unit admission in patients from public hospitals. CONCLUSION In this sample of critically ill children from five countries in Latin America, the prevalence of septic shock within the first 24 hours at admission and sepsis-related mortality were higher in public hospitals than in private hospitals. Higher sepsis-related mortality in children admitted to public pediatric intensive care units was associated with greater severity on pediatric intensive care unit admission but not with the type of hospital. New studies will be necessary to elucidate the causes of the higher prevalence and mortality of pediatric sepsis in public hospitals.
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Affiliation(s)
- Daniela Carla Souza
- Unidade de Terapia Intensiva Pediátrica, Hospital Universitário, Universidade de São Paulo - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva Pediátrica, Hospital Sírio-Libanês - São Paulo (SP), Brasil
| | - Eliane Roseli Barreira
- Unidade de Terapia Intensiva Pediátrica, Hospital Universitário, Universidade de São Paulo - São Paulo (SP), Brasil.,Departamento de Emergência, Hospital Israelita Albert Einstein - São Paulo (SP), Brasil
| | - Huei Hsin Shieh
- Unidade de Terapia Intensiva Pediátrica, Hospital Universitário, Universidade de São Paulo - São Paulo (SP), Brasil
| | | | - Albert Bousso
- Departamento de Pediatria, Escola Médica, Hospital Israelita Albert Einstein - São Paulo (SP), Brasil.,Hospital Municipal Vila Santa Catarina - São Paulo (SP), Brasil
| | - Eduardo Juan Troster
- Departamento de Medicina, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva Pediátrica, Hospital Israelita Albert Einstein - São Paulo (SP), Brasil
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Horvat CM, Simon DW, Aldewereld Z, Evans I, Aneja R, Carcillo JA. Merging Pediatric Index of Mortality (a physiologic instability measure), lactate, and Systemic Inflammation Mortality Risk to better predict outcome in pediatric sepsis. J Pediatr (Rio J) 2021; 97:256-259. [PMID: 33242412 PMCID: PMC9432282 DOI: 10.1016/j.jped.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Christopher M Horvat
- University of Pittsburgh Medical Center (UPMC), Children's Hospital of Pittsburgh, Department of Critical Care Medicine, Pittsburgh, PA, USA
| | - Dennis W Simon
- University of Pittsburgh Medical Center (UPMC), Children's Hospital of Pittsburgh, Department of Critical Care Medicine, Pittsburgh, PA, USA
| | - Zachary Aldewereld
- University of Pittsburgh Medical Center (UPMC), Children's Hospital of Pittsburgh, Department of Critical Care Medicine, Pittsburgh, PA, USA
| | - Idris Evans
- University of Pittsburgh Medical Center (UPMC), Children's Hospital of Pittsburgh, Department of Critical Care Medicine, Pittsburgh, PA, USA
| | - Rajesh Aneja
- University of Pittsburgh Medical Center (UPMC), Children's Hospital of Pittsburgh, Department of Critical Care Medicine, Pittsburgh, PA, USA
| | - Joseph A Carcillo
- University of Pittsburgh Medical Center (UPMC), Children's Hospital of Pittsburgh, Department of Critical Care Medicine, Pittsburgh, PA, USA.
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Rodrigues LDS, Rodrigues LDS, Costa LC, Fontoura GMG, Maciel MCG. Trend in infant mortality rate caused by sepsis in Brazil from 2009 to 2018. Rev Inst Med Trop Sao Paulo 2021; 63:e26. [PMID: 33852709 PMCID: PMC8046506 DOI: 10.1590/s1678-9946202163026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/11/2021] [Indexed: 12/29/2022] Open
Abstract
Sepsis is the organ dysfunction resulting from an infection associated with an
unregulated host inflammatory response, which generates high mortality rates in
Brazil. The aim of this stydy was to analyze the trend of early, late and
post-neonatal mortality rates due to sepsis in Brazilian regions, from 2009 to
2018. This is an ecological study of time series. The trend of infant mortality
from sepsis was analyzed using the International Classification of Diseases
(ICD10) according to the place of residence (North, Northeast, Southeast, South
and Midwest). Death Certificate data were collected from the Mortality
Information System database. The temporal trend was analyzed using the
Prais-Winsten estimate, interpreted as increasing, decreasing or stable, through
the dependent variable (logarithm of mortality rates) and interdependent
variables (years of the historical series). The Stata 14.0 statistical software
was used. There were 39,867 infant deaths due to sepsis (78.67% for unspecified
bacterial sepsis of the neonate ). Most of the children were male, had mixed
ethnicity (black and white) , were born preterm with low birth weight and most
mothers were 20-34 years old. There were decreasing trends in mortality rates
from 2009 to 2018: early neonatal, in the Southeast (-3.57%), North (-3.33%) and
South (-2.91%); late neonatal, in the South (-4.12%), Southeast (-4.53%), North
(-4.55%) and Midwest (-6.21%); and post-neonatal, in the Northeast (-1.84%),
North (-3.62%), Southeast (-3.83%) and Midwest (-5.81%). The Northeast showed a
stable trend in early and late neonatal mortality rates. It was concluded that
most regions showed a decreasing trend in mortality rates from sepsis in all age
components, despite regional differences.
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Affiliation(s)
- Liliane Dos Santos Rodrigues
- Universidade Federal do Maranhão, Programa de Pós-Graduação em Biodiversidade e Biotecnologia da Amazônia Legal (Rede Bionorte), São Luís, Maranhão, Brazil
| | - Livia Dos Santos Rodrigues
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Ribeirão Preto, São Paulo, Brazil
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Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, Colombara DV, Ikuta KS, Kissoon N, Finfer S, Fleischmann-Struzek C, Machado FR, Reinhart KK, Rowan K, Seymour CW, Watson RS, West TE, Marinho F, Hay SI, Lozano R, Lopez AD, Angus DC, Murray CJL, Naghavi M. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet 2020; 395:200-211. [PMID: 31954465 PMCID: PMC6970225 DOI: 10.1016/s0140-6736(19)32989-7] [Citation(s) in RCA: 2986] [Impact Index Per Article: 746.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/11/2019] [Accepted: 11/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sepsis is life-threatening organ dysfunction due to a dysregulated host response to infection. It is considered a major cause of health loss, but data for the global burden of sepsis are limited. As a syndrome caused by underlying infection, sepsis is not part of standard Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimates. Accurate estimates are important to inform and monitor health policy interventions, allocation of resources, and clinical treatment initiatives. We estimated the global, regional, and national incidence of sepsis and mortality from this disorder using data from GBD 2017. METHODS We used multiple cause-of-death data from 109 million individual death records to calculate mortality related to sepsis among each of the 282 underlying causes of death in GBD 2017. The percentage of sepsis-related deaths by underlying GBD cause in each location worldwide was modelled using mixed-effects linear regression. Sepsis-related mortality for each age group, sex, location, GBD cause, and year (1990-2017) was estimated by applying modelled cause-specific fractions to GBD 2017 cause-of-death estimates. We used data for 8·7 million individual hospital records to calculate in-hospital sepsis-associated case-fatality, stratified by underlying GBD cause. In-hospital sepsis-associated case-fatality was modelled for each location using linear regression, and sepsis incidence was estimated by applying modelled case-fatality to sepsis-related mortality estimates. FINDINGS In 2017, an estimated 48·9 million (95% uncertainty interval [UI] 38·9-62·9) incident cases of sepsis were recorded worldwide and 11·0 million (10·1-12·0) sepsis-related deaths were reported, representing 19·7% (18·2-21·4) of all global deaths. Age-standardised sepsis incidence fell by 37·0% (95% UI 11·8-54·5) and mortality decreased by 52·8% (47·7-57·5) from 1990 to 2017. Sepsis incidence and mortality varied substantially across regions, with the highest burden in sub-Saharan Africa, Oceania, south Asia, east Asia, and southeast Asia. INTERPRETATION Despite declining age-standardised incidence and mortality, sepsis remains a major cause of health loss worldwide and has an especially high health-related burden in sub-Saharan Africa. FUNDING The Bill & Melinda Gates Foundation, the National Institutes of Health, the University of Pittsburgh, the British Columbia Children's Hospital Foundation, the Wellcome Trust, and the Fleming Fund.
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Affiliation(s)
- Kristina E Rudd
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kareha M Agesa
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Derrick Tsoi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kevin S Ikuta
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Niranjan Kissoon
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | | | - Flavia R Machado
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, Brazil
| | - Konrad K Reinhart
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Anästhesiologie mit Sp operative Intensivmeidzin, Charité University Medical Center Berlin, Berlin, Germany
| | - Kathryn Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK; Faculty of Public Health & Policy linked to the Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - R Scott Watson
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - T Eoin West
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Fatima Marinho
- Institute of Advanced Studies, University of São Paulo, São Paulo, Brazil
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; University of Melbourne, Melbourne, QLD, Australia
| | - Derek C Angus
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
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11
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Souza DCD, Brandão MB, Piva JP. From the International Pediatric Sepsis Conference 2005 to the Sepsis-3 Consensus. Rev Bras Ter Intensiva 2019; 30:1-5. [PMID: 29742230 PMCID: PMC5885223 DOI: 10.5935/0103-507x.20180005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 08/14/2017] [Indexed: 01/11/2023] Open
Affiliation(s)
- Daniela Carla de Souza
- Unidade de Terapia Intensiva Pediátrica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Barciela Brandão
- Unidade de Terapia Intensiva Pediátrica, Hospital das Clínicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Jefferson Pedro Piva
- Departamento de Pediatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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12
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de Souza DC, Machado FR. Epidemiology of Pediatric Septic Shock. J Pediatr Intensive Care 2018; 8:3-10. [PMID: 31073502 DOI: 10.1055/s-0038-1676634] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/11/2018] [Indexed: 12/18/2022] Open
Abstract
Sepsis, or dysregulated host response to infection, is considered a worldwide public health problem. It is a major childhood disease both in terms of frequency and severity, and severe sepsis is still considered the main cause of death from infection in childhood. This review provides an overview of the epidemiology of pediatric septic shock. The prevalence of severe sepsis and septic shock among hospitalized children ranges from 1 to 26%. Mortality is high, ranging from 5% in developed countries to up to 35% in developing countries. However, 10 years after the publication of pediatric sepsis definitions, a global perspective on the burden of this disease in childhood is still missing. Major obstacles to a better knowledge of sepsis epidemiology in children are the absence of an adequate disease definition and not having sepsis as a cause of death in the World Health Organization Global Burden of Disease Report, which is one of the most important sources of information for health policies decision-making in the world. Several studies performed in both developed and developing countries have shown that mortality from septic shock is high and is associated with delayed diagnosis, late treatment, and nonadherence to the treatment guidelines. Reducing mortality from sepsis in childhood is a worldwide challenge, especially in developing countries, where the highest number of cases and deaths are recorded and where financial resources are scarce. Many specialists consider that prevention, education, and organization are key to achieve a reduction in the burden of sepsis.
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Affiliation(s)
- Daniela Carla de Souza
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil.,Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitário da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Flávia Ribeiro Machado
- Department of Anesthesiology, Pain and Intensive Care, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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13
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Canarie MF, Shenoi AN. Teaching the Principles of Pediatric Critical Care to Non-Intensivists in Resource Limited Settings: Challenges and Opportunities. Front Pediatr 2018; 6:44. [PMID: 29552547 PMCID: PMC5840157 DOI: 10.3389/fped.2018.00044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/14/2018] [Indexed: 01/17/2023] Open
Affiliation(s)
- Michael F Canarie
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Asha N Shenoi
- Department of Pediatrics, University of Kentucky, Lexington, KY, United States
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Abstract
OBJECTIVES Little is known about the ongoing mortality risk and healthcare utilization among U.S. children after discharge from a hospitalization involving ICU care. We sought to understand risks for hospital readmission and trends in mortality during the year following ICU discharge. DESIGN Retrospective observational cohort study. SETTING This study was performed using administrative claims data from 2006-2013 obtained from the Truven Health Analytics MarketScan Database. SUBJECTS We included all children in the dataset admitted to a U.S. ICU less than or equal to 18 years old. INTERVENTIONS The primary outcome was nonelective readmission in the year following discharge. Risk of rehospitalization was determined using a Cox proportional hazards model. MEASUREMENTS AND MAIN RESULTS We identified 109,130 children with at least one ICU admission in the dataset. Over three quarters of the index ICU admissions (78.6%) had an ICU length of stay less than or equal to 3 days, and the overall index hospitalization mortality rate was 1.4%. In multivariate analysis, risk of nonelective readmission for children without cancer was higher with longer index ICU admission length of stay, younger age, and several chronic and acute conditions. By the end of the 1-year observation period, 36.0% of children with an index ICU length of stay greater than or equal to 14 days had been readmitted, compared with only 13.9% of children who had an index ICU length of stay equals to 1 day. Mortality in the year after ICU discharge was low overall (106 deaths per 10,000 person-years of observation) but was high among children with an initial index ICU admission length of stay greater than or equal to 14 days (599 deaths per 10,000 person-years). CONCLUSIONS Readmission after ICU care is common. Further research is needed to investigate the potentially modifiable factors affecting likelihood of readmissions after discharge from the ICU. Although late mortality was relatively uncommon overall, it was 10-fold higher in the year after ICU discharge than in the general U.S. pediatric population.
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Abstract
OBJECTIVES To report the prevalence of sepsis within the first 24 hours at admission and the PICU sepsis-related mortality among critically ill children admitted to PICU in South America. DESIGN A prospective multicenter cohort study. SETTING Twenty-one PICU, located in five South America countries. PATIENTS All children from 29 days to 17 years old admitted to the participating PICU between June 2011 and September 2011. Clinical, demographic, and laboratory data were registered within the first 24 hours at admission. Outcomes were registered upon PICU discharge or death. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the 1,090 patients included in this study, 464 had sepsis. The prevalence of sepsis, severe sepsis, and septic shock were 42.6%, 25.9%, and 19.8%, respectively. The median age of sepsis patients was 11.6 months (interquartile range, 3.2-48.7) and 43% had one or more prior chronic condition. The prevalence of sepsis was higher in infants (50.4%) and lower in adolescents (1.9%). Sepsis-related mortality was 14.2% and was consistently higher with increased disease severity: 4.4% for sepsis, 12.3% for severe sepsis, and 23.1% for septic shock. Twenty-five percent of deaths occurred within the first 24 hours at PICU admission. Multivariate analysis showed that higher Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores, the presence of two or more chronic conditions, and admission from pediatric wards were independently associated with death. CONCLUSIONS We observed high prevalence of sepsis and sepsis-related mortality among this sample of children admitted to PICU in South America. Mortality was associated with greater severity of illness at admission and potentially associated with late PICU referral.
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Pedro TDCS, Morcillo AM, Baracat ECE. Etiology and prognostic factors of sepsis among children and adolescents admitted to the intensive care unit. Rev Bras Ter Intensiva 2016; 27:240-6. [PMID: 26465245 PMCID: PMC4592118 DOI: 10.5935/0103-507x.20150044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/25/2015] [Indexed: 12/20/2022] Open
Abstract
Objective To determine the etiology and clinical disease progression variables of sepsis
associated with the prognosis of patients admitted to a pediatric intensive care
unit. Methods Prospective and retrospective case series. Data were collected from the medical
records of patients diagnosed with sepsis who were admitted to the pediatric
intensive care unit of a general hospital from January 2011 to December 2013.
Bacteria were identified in blood and fluid cultures. Age, sex, vaccination
schedule, comorbidities, prior antibiotic use, clinical data on admission, and
complications during disease progression were compared in the survival and death
groups at a 5% significance level. Results A total of 115 patients, with a mean age of 30.5 months, were included in the
study. Bacterial etiology was identified in 40 patients. Altered peripheral
perfusion on admission and diagnosis of severe sepsis were associated with
complications. A greater number of complications occurred in the group of patients
older than 36 months (p = 0.003; odds ratio = 4.94). The presence of complications
during hospitalization was associated with death (odds ratio = 27.7). The main
etiological agents were Gram-negative bacteria (15/40), Staphylococcus
aureus (11/40) and Neisseria meningitidis (5/40). Conclusion Gram-negative bacteria and Staphylococcus aureus predominated in
the etiology of sepsis among children and adolescents admitted to an intensive
care unit. The severity of sepsis and the presence of altered peripheral perfusion
on admission were associated with complications. Moreover, the presence of
complications was a factor associated with death.
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Affiliation(s)
- Taís da Costa São Pedro
- Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, BR
| | - André Moreno Morcillo
- Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, BR
| | - Emílio Carlos Elias Baracat
- Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, BR
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Kissoon N, Carapetis J. Pediatric sepsis in the developing world. J Infect 2015; 71 Suppl 1:S21-6. [DOI: 10.1016/j.jinf.2015.04.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
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Reinhart K, Daniels R, Machado FR. The burden of sepsis: a call to action in support of World Sepsis Day 2013. Rev Bras Ter Intensiva 2015; 25:3-5. [PMID: 23887752 PMCID: PMC4031861 DOI: 10.1590/s0103-507x2013000100002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Konrad Reinhart
- Department of Anesthesiology and Intensive Care Medicine Erlanger Allee 10107747 Jena, Germany.
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20
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Bhagwanjee S, Ugarte S. Sepsis in vulnerable populations. Glob Heart 2014; 9:281-8. [PMID: 25667179 DOI: 10.1016/j.gheart.2014.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 08/18/2014] [Indexed: 12/29/2022] Open
Abstract
Despite the acquisition of a large body of evidence, there are many unanswered questions about sepsis. The definition of this disease is plagued by the lack of a simple pathophysiological description linking cause to effect and the activation of host immune responses that hinders disease progression at the same time producing multiorgan dysfunction. A plethora of inconsistent clinical features has served to obfuscate rather than illuminate. The Surviving Sepsis Guidelines (SSG) are a major advance because it comprehensively interrogates all aspects of care for the critically ill. For vulnerable populations living in low- and middle-income countries, this guideline is ineffectual because of the lack of region-specific data, differences in etiology of sepsis and burden of disease, limited human capacity and infrastructure, as well as socioeconomic realities. Appropriate care must be guided by common sense guidelines that are sensitive to local realities and adapted as relevant data are acquired.
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Affiliation(s)
- Satish Bhagwanjee
- Department of Anaesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.
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Systems for Paediatric Sepsis: A Global Survey. W INDIAN MED J 2014; 63:703-10. [PMID: 25867557 DOI: 10.7727/wimj.2013.326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 01/21/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate the resources available for early diagnosis and treatment of paediatric sepsis at hospitals in developing and developed countries. METHODS This was a voluntary online survey involving 101 hospitals from 41 countries solicited through the World Federation of Pediatric Intensive and Critical Care Societies contact list and website. The survey was designed to assess the spectrum of sepsis epidemiology, patterns of applied therapies, availability of resources and barriers to optimal sepsis treatment. RESULTS Ninety per cent of respondents represented a tertiary or general hospital with paediatric intensive care facilities, including 63% from developed countries. Adequate triage services were absent in more than 20% of centres. Insufficiently trained personnel and lack of a sepsis protocol was reported in 40% of all sites. While there were specific guidelines for sepsis management in 78% of centres (n = 100), protocols for assessing sepsis patients were not applied in nearly 70% of centres. Lack of parental recognition of sepsis and failure of referring centres to diagnose sepsis were identified as major barriers by more than 50% of respondents. CONCLUSIONS Even among centres with no significant resource constraints and advanced medical systems, significant deficits in sepsis care exist. Early recognition and management remain a key issue and may be addressed through improved triage, augmented support for referring centres and public awareness. Focussed research is necessary at the institutional level to identify and address specific barriers.
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Jabandziev P, Smerek M, Michalek J, Fedora M, Kosinova L, Hubacek JA, Michalek J. Multiple gene-to-gene interactions in children with sepsis: a combination of five gene variants predicts outcome of life-threatening sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R1. [PMID: 24383711 PMCID: PMC4056441 DOI: 10.1186/cc13174] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 10/31/2013] [Indexed: 12/25/2022]
Abstract
Introduction The aim of the study was to identify the dependency structure of genetic variants that can influence the outcome for paediatric patients with sepsis. Methods We evaluated the role of single nucleotide polymorphisms for five genes: bactericidal permeability increasing protein (BPI; rs5743507), lipopolysaccharide-binding protein (LBP; rs2232618), toll-like receptor 4 (TLR4; rs4986790), heat shock protein 70 (HSP 70; rs2227956), and interleukin 6 (IL-6; rs1800795) in 598 children aged 0 to 19 years that were admitted to a paediatric intensive care unit with fever, systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock, or multiple organ dysfunction syndrome. A control group of 529 healthy individuals was included. Multi-way contingency tables were constructed and statistically evaluated using log-linear models. Typical gene combinations were found for both study groups. Results Detailed analyses of the five studied gene profiles revealed significant differences in sepsis survival. Stratification into high-risk, intermediate-risk, and low-risk groups of paediatric patients can predict the severity of sepsis. Conclusions Analysis of single nucleotide polymorphisms for five genes can be used as a predictor of sepsis outcome in children.
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Reinhart K, Daniels R, Kissoon N, O'Brien J, Machado FR, Jimenez E. The burden of sepsis-a call to action in support of World Sepsis Day 2013. J Crit Care 2013; 28:526-8. [PMID: 23747158 DOI: 10.1016/j.jcrc.2013.04.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 04/28/2013] [Indexed: 11/19/2022]
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Shukri K. The Burden of Sepsis; A Call to Action in Support of World Sepsis Day 2013. Bull Emerg Trauma 2013; 1:52-55. [PMID: 27162824 PMCID: PMC4771223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/04/2013] [Accepted: 03/10/2013] [Indexed: 06/05/2023] Open
Affiliation(s)
- Khalid Shukri
- Department of Anesthesia and Intensive care, Taiba Hospital, Kuwait
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What’s New in the Recognition and Management of Septic Shock in Children: Dos and Don'ts. CURRENT PEDIATRICS REPORTS 2013. [DOI: 10.1007/s40124-012-0007-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Reinhart K, Kissoon N“T, Daniels R, Marshall J, Dellinger P, Jimenez EJ. What we learned from the first World Sepsis Day. J Crit Care 2012; 27:735-6. [DOI: 10.1016/j.jcrc.2012.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 09/28/2012] [Indexed: 11/27/2022]
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Reinhart K, Kissoon N“T, Daniels R, Jimenez EJ. Stop sepsis—save lives: A call to join the global coalition for the World Sepsis Day. J Crit Care 2012; 27:410-3. [DOI: 10.1016/j.jcrc.2012.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
John Marshall discusses new research detailing the early onset in liver dysfunction in a rodent sepsis model, which he says can fundamentally change our understanding of this common clinical problem.
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Affiliation(s)
- John C Marshall
- Departments of Surgery and Critical Care Medicine, and the Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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