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)

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

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

<p>They do not adequately address the unique challenges faced by these countries. (D)</p> 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?

<p>Sociedad Latinoamericana de Cuidados Intensivos Pediátricos (SLACIP) (B)</p> 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?

<p>Differences in the quality and availability of healthcare services. (A)</p> 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?

<p>Diarrheal disease. (E)</p> Signup and view all the answers

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

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

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

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

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

<p>Blood glucose monitoring. (B)</p> Signup and view all the answers

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

<p>When the source of infection is genitourinary or gastrointestinal. (D)</p> 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?

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

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

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

When should noradrenaline be used in patients with septic shock?

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

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

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

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

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

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

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

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

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

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

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

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

<p>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)</p> Signup and view all the answers

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

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

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

<p>Leteurtre S, Duhamel A, Salleron J, et al. (C)</p> 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?

<p>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)</p> Signup and view all the answers

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

<p>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)</p> Signup and view all the answers

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

<p>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)</p> Signup and view all the answers

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

<p>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)</p> Signup and view all the answers

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

<p>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)</p> Signup and view all the answers

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

<p>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)</p> Signup and view all the answers

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

<p>Early recognition of sepsis (D)</p> Signup and view all the answers

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

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

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

<p>The number of domains addressed (B)</p> Signup and view all the answers

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

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

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

<p>Acute kidney injury (B)</p> Signup and view all the answers

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

<p>They emphasize the availability of basic systems (A)</p> Signup and view all the answers

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

<p>World Health Organization (A)</p> Signup and view all the answers

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

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

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

<p>Definitions for pediatric sepsis (D)</p> Signup and view all the answers

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

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

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

<p>Adapting definitions and guidelines to local contexts (C)</p> Signup and view all the answers

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

<p>Sepsis (B)</p> Signup and view all the answers

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

<p>The Global Burden of Disease Study (A)</p> Signup and view all the answers

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

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

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

<p>Lack of awareness and education (B)</p> Signup and view all the answers

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

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

Flashcards

Fatal Sepsis Rates

The percentage of fatal cases of sepsis in a population.

SSC Guidelines

Recommendations for sepsis treatment based on best practices.

Child Mortality Risk

Increased chance of death from sepsis in young children.

Non-Communicable Chronic Diseases

Long-term health conditions not transmitted between people.

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Common Causes of Sepsis

Primary infections leading to sepsis, especially in children.

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Sepsis Prevalence in Regions

The occurrence rate of sepsis cases in different continents.

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Healthcare Access Limitations

Factors that restrict obtaining medical care in certain areas.

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LARed Network

A collaborative pediatric network focused on improving sepsis care.

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Haemophilus spp

A genus of bacteria that can cause infections.

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Methicillin-resistant Staphylococcus aureus (MRSA)

A type of bacteria resistant to many antibiotics, including methicillin.

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Vasoactive drug administration

Medicines used to manage blood pressure in critical situations.

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Septic shock

A severe infection causing dangerously low blood pressure and organ failure.

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Monitoring in septic shock

Assessment of vital signs and patient status in septic shock.

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ESBL-producing enterobacteria

Bacteria that produce enzymes making them resistant to common antibiotics.

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Fungal colonization

Presence of fungi in the body, potentially leading to infection.

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Liposomal amphotericin B

An antifungal medication used for severe fungal infections.

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Pediatric SOFA Score

A scoring system to predict organ dysfunction in critically ill children.

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Sepsis-3 Definitions

Updated definitions for sepsis and septic shock focusing on organ failure and infection.

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Fluid Resuscitation

The process of administering fluids to treat sepsis-related shock and dehydration.

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PELOD-2 Score

A pediatric score used to assess organ dysfunction and predict outcomes in critically ill children.

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Mortality after Fluid Bolus

The increased risk of death in African children following aggressive fluid administration.

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Balanced Solutions in Resuscitation

Use of balanced intravenous fluids in treating pediatric sepsis to improve survival.

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Septic Shock Patterns

Distinct hemodynamic patterns observed in septic shock among children.

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Recognition of Fluid Overload

Identifying excess fluid accumulation, which can complicate treatment in critically ill children.

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Dopamine vs Epinephrine

Comparison of two vasoactive drugs in treating pediatric septic shock.

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Delayed Antimicrobial Therapy

Waiting too long to give antibiotics increases mortality in pediatric sepsis.

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Multiple Organ Dysfunction

Condition where two or more organs fail in critically ill pediatric patients.

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Early Corticosteroid Therapy

Use of steroids early in treatment to manage pediatric septic shock.

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Ventilatory Management

Strategies to maintain adequate ventilation in patients.

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Vasoactive Medications

Drugs that affect vascular tone and blood pressure.

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pSOFa and PELOD-2

Severity scales used to predict mortality in sepsis.

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Sepsis Bundle

A set of clinical practices aimed at early recognition and management of sepsis.

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Clinical Operationalization

Translating the definition of sepsis into clinical practice.

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Mortality Rate in LMICs

Higher mortality rates due to limited resources in low- and middle-income countries.

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Chronic Noncommunicable Diseases

Long-term health conditions like diabetes and heart disease prevalent in certain regions.

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Sepsis

A life-threatening condition caused by the body's response to infection, leading to tissue damage and organ failure.

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ICU

Intensive Care Unit, a specialized department for critically ill patients requiring constant monitoring and support.

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Acute kidney injury

A sudden episode of kidney failure or damage, commonly occurring in severe sepsis patients.

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Case-fatality rate

The proportion of individuals with a particular condition who die from that condition.

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Global burden of disease study

Research assessing the impact of diseases worldwide, including incidence and mortality rates.

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Surviving sepsis campaign

An initiative aimed at reducing mortality from sepsis through guidelines and practices.

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Sepsis definitions task force

A group responsible for creating clear definitions and guidelines for diagnosing and treating sepsis.

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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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