Assessment of adherence to the 2020 Surviving Sepsis Campaign guidelines for fluid resuscitation in children with suspected septic shock in paediatric emergency departments: a prospective multicentre study

Arch Dis Child. 2024 Jul 18;109(8):636-641. doi: 10.1136/archdischild-2023-325837.

Abstract

Background: Paediatric sepsis is the leading cause of death in children under 5 years. No studies have evaluated the application of the Surviving Sepsis Campaign 2020 (SSC-2020) guidelines in paediatric emergency departments (PEDs).

Objective: To assess physician adherence to the SSC-2020 fluid resuscitation guidelines in children with suspected septic shock in PEDs.

Methods: This was a prospective multicentre observational study conducted in 21 French hospitals over 5 sequential weeks, between November 2021 and March 2022. Children with suspected septic shock and who received antimicrobial therapy within 72 hours were included. Primary outcome was SSC-2020 fluid resuscitation guidelines adherence (low 0-24%; moderate 25-74%; high 75-100%) according to: bolus volume of 10-20 mL/kg each, exclusive administration of balanced crystalloids at 1 and 24 hours of management, and initiation of fluid resuscitation within 1 hour of septic shock recognition.

Results: 63 children were included. 10 (16%) children had severe sepsis and 2 (3%) met the definition of septic shock. Compared with the SSC-2020 guidelines, 43 (68%) patients received boluses of 10-20 mL/kg; fluid resuscitation was initiated within 1 hour of septic shock recognition in 42 (76%) cases; balanced crystalloids were the only fluids administrated in 35 (56%) and 34 (55%) children at 1 and 24 hours of management, respectively. Main barriers reported by physicians were difficult intravenous access (43%), lack of team training (29%), workload constraints (28%), and absence or out-of-date protocols (24%).

Conclusions: This study found high adherence for fluid resuscitation initiation but moderate adherence for bolus volume and fluid choice.

Trial registration number: NCT05066464.

Keywords: Emergency Care; Intensive Care Units, Paediatric; Paediatric Emergency Medicine; Paediatrics; Sepsis.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Child
  • Child, Preschool
  • Crystalloid Solutions / administration & dosage
  • Crystalloid Solutions / therapeutic use
  • Emergency Service, Hospital* / standards
  • Emergency Service, Hospital* / statistics & numerical data
  • Female
  • Fluid Therapy* / methods
  • Fluid Therapy* / standards
  • France
  • Guideline Adherence* / statistics & numerical data
  • Humans
  • Infant
  • Male
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / standards
  • Practice Patterns, Physicians' / statistics & numerical data
  • Prospective Studies
  • Resuscitation* / methods
  • Resuscitation* / standards
  • Shock, Septic* / therapy

Substances

  • Crystalloid Solutions

Associated data

  • ClinicalTrials.gov/NCT05066464