Pediatric Sepsis Criteria, Definitions and Specific Features
Vanyan-Sabaliauskiene, Polina |
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AUTHOR: Polina Vanyan-Sabaliauskienė TITLE: Pediatric Sepsis Criteria, Definitions and Specific Features AIM: This research chiefly aims to assess existing approaches to pediatric sepsis pathophysiology and criteria. OBJECTIVES: 1. Comparison of pediatric and adult sepsis definitions. 2.Assessment of the existing evidence of pediatric sepsis pathophysiology and criteria. 3. Comparison of pediatric and adult sepsis pathophysiology and criteria METHODOLOGY: A literature search was carried out in scientific database MEDLINE via PubMed for primary and secondary data comparing adult and pediatric sepsis. The identified literature was reviewed and summarized, important differences in pathophysiology, definitions and diagnostic criteria were highlighted. RESULTS & DISCUSSION: Adult and pediatric differ in host responses to infection at organism, organ system, and cellular-molecular level. The two populations are distinct in terms of underlying comorbidities and risk factors, implicated pathogens, cardiovascular responses to hypovolemia and fluid redistributions, insensible fluid losses, respiratory pathway pressure, and respective management strategies. The fluid bolus resuscitation remains the mainstay of septic shock management in children. In contrast to the „warm shock” pattern of reduced systemic vascular resistance with increased cardiac output observed in adults, pediatric patients more commonly manifest pronounced decline in stroke volume and cardiac output, accompanied by increases in systemic vascular resistance – a „cold shock”. Accordingly, inotropic support is more often emphasized in pediatric care, whereas vasopressors are preferred when managing adults with sepsis. Early use of noninvasive positive pressure ventilation has promises for improving oxygenation, vital indices, and reducing intubation rates in pediatric sepsis. However, optimal ventilator strategy remains unknown for children, and extrapolation from adult studies is to be carried out cautiously, considering their distinct epidemiology and outcomes. Studies support using stratified scoring systems for organ dysfunction over systemic inflammatory response syndrome (SIRS) criteria in children, and efforts to update the definition and clinical criteria for pediatric sepsis are currently underway. Until revised and data-driven clinical criteria are determined to better describe pediatric sepsis and septic shock, current medical care often adopts adult practices that are not universally plausible for extrapolation over pediatric population. Comparing the older SIRS-based definitions and recent approaches with SOFA/PELOD items, the latter appear to outperform at identifying children with life-threatening infections. The numerous promising biomarkers fail to provide sufficient utility to be exclusively relied on, and the current use assumes their additive value when considered in entirety of the clinical scenario and other clinical-laboratory variables. CONCLUSION: There appear to be profound and clinically important differences in underlying comorbid conditions, identified pathogens, pathophysiology, hemodynamic and respiratory processes, total body fluid dynamics, and biomarker utility in adult and pediatric populations with sepsis of. Such differences should be considered in the respective criteria for diagnosis, prognosis and triage of patients with sepsis and septic shock.
Šiame darbe apžvelgti ir susisteminti 103 literatūros šaltiniai iš tarptautinių Pubmed ir Cohrane duomenų bazių. Apibendrinti vaikų sepsio apibrėžimo, kriterijų ir patofiziologijos moksliniai įrodymai, taip pat atspindėti vaikų ir suaugusiųjų sepsio skirtumai, akcentuojant vaikų sepsio patogenezės įvairovę ir su tuo susijusius sepsio kriterijų ir apibrėžimo tobulinimo iššūkius.