Revisao - Ano 2024 - Volume 14 - Número 4
Summary: International Consensus Criteria for Pediatric Sepsis and Septic Shock
Summary: International Consensus Criteria for Pediatric Sepsis and Septic Shock
The International Consensus Criteria for Pediatric Sepsis and Septic Shock was proposed by a task force of 35 pediatric medicine and nursing specialists working in intensive care, emergency care, and infectious diseases from 12 countries on six continents. The consensus document was developed in three stages: a global survey with 2835 healthcare professionals, a systematic review and meta-analysis, and a derivation and validation study based on 3,000,000 electronic medical records of inpatients under 18 (excluding preterm infants younger than 37 weeks and newborns hospitalized after birth) from ten locations on four continents (including low-, middle-, and high-income countries). A Delphi consensus was used in the development of the criteria.
Eight organ dysfunction scores were used as the basis for the study to determine which systems were stronger predictors of hospital mortality in children with infection. From there, two scores were created, one comprising four systems (cardiovascular, respiratory, neurological, and coagulation) and another with eight (the previous four plus the renal, hepatic, endocrine, and immune systems), demonstrating similar performance. Due to greater simplicity in application, greater dissemination capacity, and less dependence on laboratory tests, the score with four systems was used to define the Phoenix criteria (Table 1). The exclusion of other systems, such as the renal and hepatic systems, does not diminish their relevance in patient management.
In the Phoenix score, sepsis was defined as a suspected infection plus a score of two or more points. Septic shock was defined as sepsis plus a score of 1 or more points in the "cardiovascular system" category. The term "severe sepsis" should no longer be used since sepsis is itself a life-threatening condition and a severe health condition.
The Phoenix Sepsis score demonstrated greater sensitivity and positive predictive value when compared to the 2005 criteria.
The new criteria for sepsis and septic shock aim to identify life-threatening organ dysfunctions secondary to infections in children. They were not developed to screen at-risk children or to identify early sepsis and septic shock.
The new consensus has rekindled discussions on the topic. Particular attention has been devoted to the creation of screening instruments to identify cases of sepsis early on and patients at risk so that early interventions are introduced to decrease morbidity and mortality associated with pediatric sepsis.
The Phoenix criteria can potentially enhance pediatric septic patients' care significantly. Their adoption could lead to better clinical outcomes and the inclusion of more patients in clinical studies, potentially paving the way for new therapeutic advances.
The authors conclude the article by citing the limitations of the consensus, which include the simplification of a complex and heterogeneous biological process; the use of microbiological markers, which may be affected by the availability of resources and local practices; the use of the primary outcome of death in children with infections, which, although more objective, cannot be considered in the assessment of morbidity associated with infection and does not include long-term effects for patients and their families; the criteria were not developed for patients with nosocomial infections, preterm infants younger than 37 weeks of gestational age, or full-term newborns hospitalized shortly after birth.
By adopting the Phoenix criteria, we can potentially revolutionize the clinical care of sepsis, its epidemiological assessment, and clinical research. This shift may ultimately lead to improved outcomes and reduced mortality related to pediatric sepsis.
REFERENCES:
Schlapbach LJ, Watson RS, Sorce LR, et al. International Consensus Criteria for Pediatric Sepsis and Septic Shock. JAMA. 2024 Feb 27; 331(8): 665-674. DOI: 10.1001/jama.2024.0179
1. Instituto de Puericultura e Pediatria Martagão Gesteira - Universidade Federal do Rio de Janeiro (IPPMG-UFRJ), Residência Médica em Terapia Intensiva Pediátrica (em andamento) - Rio de Janeiro - Rio de Janeiro - Brazil
2. Instituto de Puericultura e Pediatria Martagão Gesteira - Universidade Federal do Rio de Janeiro (IPPMG-UFRJ), Residência Médica em Pediatria (em andamento) - Rio de Janeiro - Rio de Janeiro - Brazil
3. Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina - Rio de Janeiro - Rio de Janeiro - Brazil
4. Instituto de Puericultura e Pediatria Martagão Gesteira - Universidade Federal do Rio de Janeiro (IPPMG-UFRJ), Unidade de Terapia Intensiva Pediátrica - Rio de Janeiro - Rio de Janeiro - Brazil
5. Instituto de Puericultura e Pediatria Martagão Gesteira - Universidade Federal do Rio de Janeiro (IPPMG-UFRJ), Divisão de Ensino e Pesquisa - Rio de Janeiro - Rio de Janeiro - Brazil
Correspondence to:
Vanessa Soares Lanziotti
Instituto de Puericultura e Pediatria Martagão Gesteira - Universidade Federal do Rio de Janeiro (IPPMG-UFRJ)
R. Bruno Lobo, 50 - Cidade Universitária
Rio de Janeiro - RJ, 21941-912
E-mail: vslanziotti@gmail.com; vslanziotti@ufrj.br
Submitted on: 07/29/2024
Approved on: 08/19/2024