Septic shock: early rapid recognition and ongoing management

Paediatric sepsis remains an important cause of morbidity and mortality in children. This review will summarize the main aspects of the definition, current evidence-base for interventions and suggest possible areas of improvement. Controversy remains regarding accurate definitions for paediatric sepsis, resuscitation fluid volume and type, choice of vasoactive agents for use in resuscitation and antibiotic choices. Many adjunctive therapies have been suggested with theoretical benefit, although few have proven beneficial. Definitive recommendations are not yet supported by data. We describe best practice recommendations based on international guidelines, a review of primary literature, and a discussion of ongoing clinical trials and the nuances of therapeutic choices. Early diagnosis and aggressive intervention with timely antibiotics, fluid resuscitation and vasoactive medications are the most important interventions in to improve outcomes. The implementation of protocols, resource-adjusted sepsis bundles and advanced technologies will impact on reducing sepsis mortality.