Sepsis

The management of the child with sepsis represents the sine qua non of pediatric critical care medicine. Overwhelming sepsis and septic shock often manifest with concurrent derangements of cardiovascular function, intravascular volume status, respiratory function, immune regulation, renal function, coagulation, hepatic function, and metabolic function – sepsis literally affects every organ system to some degree. The degree to which any of these derangements are manifest in a given child is highly variable and influenced by multiple host and pathogen factors, including the child’s developmental stage, the presence or absence of co-morbidities, the host’s immune/inflammatory state, the host’s genetic background, and the specific pathogens involved. These factors combine, in turn, to profoundly influence the ultimate outcome. Successful management of critically ill children depends upon early recognition, early treatment with antibiotics, and early reversal of shock.