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Which is more important in the management of the child with septic shock: aggressive resuscitation at the referring hospital or excellent care at the tertiary care center?
Although both are important, a recent study demonstrated that children in shock from sepsis who are aggressively resuscitated at the referring hospital have better outcomes than those who do not receive such care. Additionally, recent guidelines from the American College of Critical Care Medicine emphasize goal-directed fluid resuscitation, inotrope therapy, and antibiotic delivery within the first hour. These results support the notion that management of shock must begin as soon as it is recognized.
Sources
Brierley J, Carcillo JA, Choong K, et al: Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med 2009;37(2):666-688.
Han YY, Carcillo JA, Dragotta MA, et al: Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics 2003;112:793-799.
