Abstract 338: Determining the Timeliness of Key Resuscitative Interventions Among Pediatric Patients Treated for Septic Shock at a Pediatric Tertiary Care Hospital
Introduction: Severe sepsis and septic shock (SS) are associated with high mortality and morbidity, and interventions are time-sensitive. Adherence to evidence based guidelines is poor.
Objective: To evaluate the time required to deliver components of the American College of Critical Care Medicine guidelines for SS; vascular access, isotonic fluid bolus of 20mL/kg within 15 min, antibiotics within 15 min, and vasoactive medications.
Method: A retrospective case series to determine when SS criteria were met (Time Zero) and the timing of recommended therapies for children 29 days to 17 yrs with SS admitted to the intensive care unit at a pediatric hospital. Descriptive statistics are reported as median and ranges.
Results: Of 498 admissions between 01/06/2010 and 30/06/2011, 28 (6%) met criteria for SS; 13 (46.4%) in the emergency department, 7 (25%) on a ward and 8 (28.6%) in the ICU. Half (14) were males, median age and weight were 4.4yrs (0-17) and 19kg (2.9-85.9) and 4 (14.3%) patients died. Septic shock case outnumbered severe sepsis (21 [75%] vs 7 [25%]). Time intervals are from time zero. Vascular access was preexisting in 18 (64.3%), established in less than 15 min for 6 (21.4%), and took longer than 15 min for 4 (14.3%), where it took 23 min (19-36 min). Isotonic fluid boluses of 20mL/kg were initiated within 15 min in 12 (42.9%), otherwise boluses were initiated in 42 min (0-398 min). It took 27 min (0-113) to deliver the first 20mL/kg of fluid once initiated. Antibiotics were given before time zero for 13 (46.4%), within 15 minutes for 4 (14.3%), and in 74 minutes (16, 411) for the remaining 11 (39.3%). Vasoactive medications were given to 20 (71.4%) 4.2 hours (41min to 74 hours) after time zero. Medical emergency teams (MET) were activated for 9/20 (45%) patients who developed SS outside of the ICU. Patients arrived in ICU 4.0 hours after time zero (0-28.4 hours).
Conclusion: We found delays in pediatric SS care at an academic children’s hospital. Venous access does not seem to be a large contributor to delays, thought faster access is recommended. Further knowledge translation may improve adherence. Increasing MET response rates may improve care. Innovative processes are needed to ensure faster care so that lives can be saved.
Author Disclosures: B.L. Bigham: None. E. Aguirre: None. K. Choong: None. M.J. Parker: None.
- © 2014 by American Heart Association, Inc.