Management – Overview

The management of pediatric sepsis centers on early recognition, timely administration of antibiotics, and prompt fluid resuscitation and hemodynamic support. The goals are to rapidly treat the inciting infection, mitigate the exaggerated inflammatory response, preserve end-organ perfusion, and prevent progressive shock and multiorgan failure. Supportive care for organ dysfunction is provided. An interprofessional, protocol-driven approach is beneficial. Key principles include:

• Early administration of broad-spectrum IV antibiotics after cultures
• Initial fluid resuscitation with isotonic crystalloids targeting 20 mL/kg
• Vasoactive agents for fluid-refractory shock (dopamine, epinephrine)
• Adjuvant therapies like corticosteroids for refractory shock
• Oxygen supplementation and mechanical ventilation if needed
• Monitoring and management of coagulopathy and other lab abnormalities
• Limiting fluids once shock is resolved to avoid fluid overload
• Supportive management of organ dysfunction (e.g. renal replacement therapy)
• ICU monitoring and organ support if end-organ hypoperfusion persists

The priority is reversing shock, restoring perfusion, and preventing progression to multiorgan failure. An individualized approach is needed based on clinical response.