Latin American Sepsis Management Consensus

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Questions and Answers

What is the main focus of the guidelines discussed in the text?

To develop specific algorithms for managing sepsis in middle and low-income countries.

To provide guidelines for best practices in sepsis management, adaptable to various healthcare contexts. (correct)

To standardize care practices for sepsis across different income levels.

To establish a definitive treatment protocol for sepsis in all income levels.

What specific challenge faced by middle and low-income countries is mentioned as impacting sepsis management?

Lack of funding for research and development of new treatments.

Inadequate availability of essential medical resources and infrastructure. (correct)

Limited access to qualified healthcare professionals.

Insufficient awareness and education about sepsis among the general population.

What is the prevalence of sepsis in middle and low-income countries compared to high-income countries?

Sepsis is less common in high-income countries. (correct)

Sepsis only affects children in middle and low-income countries.

Sepsis is more common in high-income countries.

Sepsis is equally prevalent in both types of countries.

Which of the following factors are cited as contributing to higher risks of sepsis mortality in middle and low-income countries? (Select all that apply)

Shortage of trained pediatric intensive care specialists. (A), Limited availability of antibiotics and other essential medicines. (D) Signup and view all the answers

Why are the existing sepsis guidelines not completely applicable in middle and low-income countries?

They do not adequately address the unique challenges faced by these countries. (D) Signup and view all the answers

What organization is mentioned as taking steps to address the challenges of implementing existing sepsis guidelines in Latin America?

Sociedad Latinoamericana de Cuidados Intensivos Pediátricos (SLACIP) (B) Signup and view all the answers

What is the main reason for the difference in the prevalence of fatal sepsis cases between high-income and middle/low-income countries?

Differences in the quality and availability of healthcare services. (A) Signup and view all the answers

What is the most common cause of sepsis among children under five years old in 2017, according to the text?

Diarrheal disease. (E) Signup and view all the answers

What is recommended for initial empirical treatment of sepsis in areas with high prevalence of MRSA?

A third-generation cephalosporin along with an antibiotic with specific MRSA coverage. (C) Signup and view all the answers

When should vasoactive drug administration be initiated in patients with septic shock, regardless of hospital location?

As soon as possible after it is considered necessary. (A) Signup and view all the answers

Which of the following is NOT recommended for noninvasive monitoring of patients in septic shock?

Blood glucose monitoring. (B) Signup and view all the answers

In which scenario should coverage of Gram-negative bacilli be considered in children with septic shock?

When the source of infection is genitourinary or gastrointestinal. (D) Signup and view all the answers

What is a recommended treatment approach for patients with septic shock and a possible history of fungal colonization or infection?

The addition of lipid or liposomal amphotericin B or echinocandins, as applicable. (B) Signup and view all the answers

What is the recommended approach for vasoactive drug administration in patients with septic shock?

Administer via peripheral or intraosseous access, as soon as it is considered necessary. (A) Signup and view all the answers

When should noradrenaline be used in patients with septic shock?

Only in cases with evidence of low peripheral vascular resistance. (B) Signup and view all the answers

Which antibiotic should be considered for initial empirical coverage in immunosuppressed individuals with septic shock?

An antibiotic with coverage for ESBL-producing enterobacteria, Pseudomonas, and MRSA, among others. (C) Signup and view all the answers

What is the main focus of the article by Brierley and Peters?

The distinct hemodynamic patterns of septic shock in children (D) Signup and view all the answers

Which of these articles focuses on the impact of different types of fluids on children with sepsis?

Fernández-Sarmiento J, Alcalá-Lozano C, Barrera PA, et al. (A) Signup and view all the answers

Which article examines the accuracy of different scoring systems in predicting mortality for children with suspected infection?

Schlapbach LJ, Straney L, Bellomo R, et al. (A) Signup and view all the answers

What is the main focus of the article by Maitland, Kiguli, Opoka, et al.?

Mortality after fluid bolus in African children with severe infection (A) Signup and view all the answers

Which article utilizes the pSOFA score to assess mortality risk in children with sepsis?

Mohamed E-MG, Said E-MM, Helmy ZM.La escala pediátrica de evaluación del fallo multiorgánico secuencial (pSOFA): una nueva escala de predicción de la mortalidad en la unidad de cuidados intensivos pediátricos. (B) Signup and view all the answers

Which article focuses on the recognition and treatment of sepsis and septic shock in children?

Hilarius KWE, Skippen PW, Kissoon N.Early recognition and emergency treatment of sepsis and septic shock in children. (C) Signup and view all the answers

Which of these articles investigates the use of the PELOD-2 score for pediatric patients?

Leteurtre S, Duhamel A, Salleron J, et al. (C) Signup and view all the answers

Which of these studies utilizes a specific scoring system to assess the severity of organ dysfunction in children with sepsis?

Matics TJ, Sanchez-Pinto LN.Adaptation and validation of a pediatric sequential organ failure assessment score and evaluation of the sepsis-3 definitions in critically Ill children. (A) Signup and view all the answers

Which study utilizes a 'Double-Blind prospective randomized controlled trial' design to compare two different treatments?

Ventura AM, Shieh HH, Bousso A, et al. Double-Blind prospective randomized controlled trial of dopamine versus epinephrine as ﬁrst-line vasoactive drugs in pediatric septic shock. Crit Care Med. 2015;43(11):2292-2302. (B) Signup and view all the answers

Which study investigates the prevalence of Multiple Organ Dysfunction in the Pediatric Intensive Care Unit (PICU)?

Hamshary AAEE, Sherbini SAE, Elgebaly HF, et al. Prevalence of multiple organ dysfunction in the pediatric intensive care unit: pediatric risk of mortality III versus pediatric logistic organ dysfunction scores for mortality prediction. Rev Bras Ter Intensiva. 2017;29(2):206-212. (A) Signup and view all the answers

Which research primarily explores the impact of "Delayed antimicrobial therapy" on pediatric sepsis?

Weiss SL, Fitzgerald JC, Balamuth F, et al. Delayed antimicrobial therapy increases mortality and organ dysfunction duration in pediatric sepsis. Crit Care Med. 2014;42(11):2409-2417. (A) Signup and view all the answers

Which study evaluates the performance of the pediatric Index of Mortality 3 (PIM3) score in Argentina?

Arias López MDP, Boada N, Fernández A, et al. Performance of the pediatric Index of mortality 3 score in PICUs in Argentina: a Pediatr Infect Dis J. 2017;36(2):155-159. (A) Signup and view all the answers

Which study focuses on evaluating the effectiveness of "early corticosteroid therapy" in managing pediatric septic shock?

El-Nawawy A, Khater D, Omar H, et al. Evaluation of early corticosteroid therapy in management of pediatric septic shock in pediatric intensive care patients: a randomized clinical study. Pediatr Infect Dis J. 2017;36(2):155-159. (C) Signup and view all the answers

What aspect does the SSC guidelines and the discussed consensus both emphasize?

Early recognition of sepsis (D) Signup and view all the answers

Which of the following is a recommendation specifically for low- and middle-income countries (LMICs)?

Using pSOFa or PELOD-2 to predict mortality (A) Signup and view all the answers

What is a significant difference between the SSC guidelines and the discussed consensus?

The number of domains addressed (B) Signup and view all the answers

Why is the differentiation between 'definition' and 'clinical operationalization' of sepsis challenging?

Limited critical care beds make it harder to implement (A) Signup and view all the answers

What is a significant risk factor for death in pediatric severe sepsis?

Acute kidney injury (B) Signup and view all the answers

How do the recommendations regarding oxygen administration systems differ for LMICs?

They emphasize the availability of basic systems (A) Signup and view all the answers

Which organization has a campaign aimed at preventing sepsis through hand hygiene?

World Health Organization (A) Signup and view all the answers

What aspect is highlighted regarding the mortality rate in regions of Latin America?

It can be up to four times higher in nearby townships (A) Signup and view all the answers

What is the focus of the 2018 systematic review protocol by the pediatric sepsis definition taskforce?

Definitions for pediatric sepsis (D) Signup and view all the answers

What common practice is not observed in many LMICs regarding sepsis management?

Use of severity scales to evaluate residual mortality (A) Signup and view all the answers

What does the consensus suggest is important for sepsis management in LMICs?

Adapting definitions and guidelines to local contexts (C) Signup and view all the answers

What was identified as the most expensive hospital condition by payer in the report from May 2016?

Sepsis (B) Signup and view all the answers

Which study analyzed global, regional, and national sepsis incidence and mortality from 1990 to 2017?

The Global Burden of Disease Study (A) Signup and view all the answers

What does the term 'case-fatality rate' refer to in the context of pediatric severe sepsis?

The percentage of patients who die from sepsis (B) Signup and view all the answers

What is a common challenge in managing sepsis in resource-poor settings?

Lack of awareness and education (B) Signup and view all the answers

What conference defined sepsis and organ failure guidelines, including innovative therapy uses?

ACCP/SCCM Conference (D) Signup and view all the answers

Study Notes

Latin American Consensus on Sepsis Management in Children

A consensus document was created by 27 experts
Focus was on low- and middle-income countries (LMICs), specifically Latin America
The modified Delphi method was used, combining expert opinions and available evidence
The document provides 62 recommendations for diagnosing and treating pediatric sepsis in LMICs
60 of the recommendations are strong recommendations, though 56 are based on low-level evidence
This is the first consensus on this specific topic for LMICs
This consensus acknowledges limited high-level evidence available for this region

Sepsis in Children

Sepsis is a leading cause of morbidity and mortality worldwide, particularly in children in LMICs
There are an estimated 48.9 million sepsis cases globally, with a significant proportion (20.3 million) in children under 5 years of age
Mortality rates due to sepsis are higher in middle and low-income countries compared to high-income countries
Sepsis in children is frequently caused by diarrheal disease, neonatal disorders, and lower respiratory tract infections, especially in those younger than 5

Treatment Recommendations: Executive Summary

Emphasizes the importance of early recognition and prompt treatment
Recommends the use of balanced crystalloid solutions for fluid resuscitation
Adrenaline is a preferred initial vasoactive treatment
Continuous monitoring of vital signs and other hemodynamic measures is crucial for decision-making
Recommend starting empirical broad-spectrum antibiotic therapy within 1 hour of diagnosis, especially in cases of septic shock
Appropriate antibiotic selection is crucial, considering local resistance patterns.
Using bundles for treatments are a recommended way to ensure treatments are performed
Immediate referral to a higher-level care centre is recommended in cases of suspected sepsis, especially in LMICs

Essential Care for Children with Sepsis in LMICs

The consensus recognizes the need for individualized treatment plans in LMIC settings.
It stresses prompt referral to higher-level care facilities and recommends a standardized approach based on local epidemiology.
It suggests using the Pediatric Assessment Triangle (PAT) as an initial assessment tool.

Fluid Resuscitation

For healthcare systems with limited resources, bolus fluids may not be needed initially in patients without hypotension.
However, when hypotension occurs, a 10 ml/kg bolus is recommended in the first hour, up to a maximum of 40 ml/kg.

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Description

This quiz explores the Latin American Consensus on Sepsis Management in Children, which was developed by 27 experts focusing on low- and middle-income countries. It outlines 62 recommendations for diagnosis and treatment of pediatric sepsis, emphasizing the context of limited high-level evidence in these regions.