Summary and References

Pediatric sepsis is a major healthcare challenge requiring prompt recognition and treatment to prevent devastating outcomes. Pharmacists play a pivotal role in managing these high-risk patients. Key learning points include pathophysiologic processes leading to shock and organ failure, recognizing sepsis presentations, rapidly initiating antibiotics and fluids, tailoring hemodynamic support, and preventing secondary injury from fluid overload or prolonged treatments.

Landmark trials and guidelines have shaped evidence-based care protocols. However, uncertainties remain regarding optimal fluid volumes, vasopressor choices, steroid use, and adjunctive therapies. Ongoing research and quality improvements are still needed. Using clinical judgment and a meticulous, patient-centered approach is essential. With their pharmacotherapy expertise and perspective, pharmacists crucially impact care across the sepsis management spectrum.

References

1. Weiss SL, Fitzgerald JC, Pappachan J, et al. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study. Am J Respir Crit Care Med. 2015;191(10):1147-1157.
2. Davis AL, Carcillo JA, Aneja RK, et al. American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med. 2017;45(6):1061-1093.
3. Evans LV, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021;49(11):e1063-e1143.
4. Kreymann KG, de Heer G, Nierhaus A, et al. Use of polyclonal immunoglobulins as adjunctive therapy for sepsis or septic shock. Crit Care Med. 2007;35(12):2677-2685.
5. Randolph AG, Meert KL, O’Neil ME, et al. The feasibility of conducting clinical trials in infants and children with acute respiratory failure. Am J Respir Crit Care Med. 2003;167(10):1334-1340.
6. Kutko MC, Calarco MP, Flaherty MB, et al. Mortality rates in pediatric septic shock with and without multiple organ system failure. Pediatr Crit Care Med. 2003;4(3):333-337.
7. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304-377.
8. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580-637.
9. Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: For the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):775-787.
10. Scott HF, Brou L, Deakyne SJ, et al. Association between early lactate levels and 30-day mortality in clinically suspected sepsis in children. JAMA Pediatr. 2017;171(3):249-255.