Advances in the Management of Pediatric Septic Shock: Old Questions, New Answers

Septic shock in children is associated with high mortality, especially in developing countries. Management includes early recognition, timely antibiotics, aggressive fluid resuscitation, and appropriate vasoactive therapy, to achieve the therapeutic end points. The evidence at each step in management has evolved over the past decade with a paradigm shift in emphasis from a ‘protocolized care’ to an ‘individualized physiology-based care’. This shift mirrors the general trend one observes in critical care with respect to various treatment modalities i.e. moving away from a liberal to a more conservative approach be it fluids, ventilation, transfusion, antibiotics or insulin. The age-old questions of how much fluid to give, what inotropes to start, when to administer antibiotics, are steroids indicated and when to consider extracorporeal therapies in refractory shock are finding new answers from the recent spate of evidence. It is therefore imperative for all of us to be aware of the recent changes in management, to enable us to adopt an evidenced based approach while managing children with septic shock. In this review, we have tried to summarize the key changes in evidence that have occurred over the past decade at various steps in the management of pediatric septic shock.