Improving sepsis recognition and management.

Sepsis is a major contributor to morbidity and mortality world-wide, with over half of the cases occurring in the pediatric population. The World Health Organization has challenged healthcare providers and organizations to improve the prevention, diagnosis, and management of sepsis.1 While the pediatric definition for sepsis was first introduced in 2005, it has not changed since that time, and does not fully represent what occurs during sepsis. The updated adult definition focuses on the dysregulation of the host response to infection leading to life-threatening organ dysfunction. Aligning with this definition, the new Pediatric Surviving Sepsis guidelines target sepsis with end-organ dysfunction and septic shock. Recommendations include utilizing automated trigger tools embedded in the electronic health record to improve timing of recognition, as well as utilization of a standardized approach to the management, and early escalation to critical care if the patient is not responding to interventions. Rapid fluid resuscitation utilizes lactated ringers rather than normal saline due to potential concerns of worse outcomes with a large chloride infusion. 40-60 ml/kg is the recommended fluid goal in the first hour, watching for development of fluid overload which can also lead to increased morbidity and mortality. Broad-spectrum antibiotics should be initiated by the end of the first hour, especially in cases of septic shock. Implementation of systems capitalizing on the ability of the electronic health record to constantly screen patients, paired with rapid response teams who can assess and approach sepsis with a standardized algorithm can significantly improve the recognition and management of patients with sepsis, and save lives.11-13.