Suspected Pediatric Sepsis
Child with suspected infection and signs of organ dysfunction
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PediatricsEmergency
Pediatric Sepsis and Septic Shock (SSC/Phoenix 2024)
Pediatric Sepsis and Septic Shock (SSC/Phoenix 2024): Suspected Pediatric Sepsis → Recognition: Phoenix Sepsis Criteria → First Hour Bundle → Fluid Resu...
Pathway Overview
11 steps
Algorithm Steps
11 total
01Start 02Action Recognition: Phoenix Sepsis Criteria
Identify sepsis using Phoenix Score
- Sepsis = Phoenix Score ≥2 in child with suspected infection
- Phoenix Score assesses: Respiratory, Cardiovascular, Coagulation, Neurologic
- Septic Shock = Sepsis + Cardiovascular dysfunction (CV score ≥1)
- CV dysfunction: Vasoactive use OR Lactate >5 mmol/L OR MAP low for age
03Action First Hour Bundle
Time-sensitive interventions
- Obtain IV/IO access (2 large-bore if possible)
- Draw blood cultures BEFORE antibiotics (do not delay abx)
- Measure lactate
- Begin fluid resuscitation
- Administer broad-spectrum antibiotics within 1 hour
04Action Fluid Resuscitation
Isotonic crystalloid boluses
- Initial: 10-20 mL/kg balanced crystalloid or NS
- Reassess after each bolus (exam, HR, BP, cap refill, urine output)
- Repeat up to 40-60 mL/kg in first hour if needed
- Watch for fluid overload (rales, hepatomegaly, worsening oxygenation)
- In resource-limited settings: restrict to 20-40 mL/kg total
05Decision Response to Fluids?
Assess perfusion after 40-60 mL/kg fluids
- Signs of adequate perfusion:
- - Improved cap refill (<2 sec)
- - Improved mental status
- - Improving lactate
- - Adequate urine output
06Outcome Perfusion Restored
Continue monitoring, ICU admission
- Continue supportive care
- Complete antibiotic course
- Wean vasopressors as tolerated
- PICU admission for close monitoring
07Action Vasopressor Initiation
Fluid-refractory shock - start vasopressors
- FIRST-LINE: Epinephrine OR Norepinephrine (no preference)
- Epinephrine: 0.05-0.3 mcg/kg/min (may use peripherally initially)
- Norepinephrine: 0.05-1 mcg/kg/min
- Titrate to MAP appropriate for age
- Consider central access for prolonged vasopressor use
08Action Ongoing Monitoring
Continuous reassessment
- Serial lactate measurements
- Urine output (goal >0.5 mL/kg/hr)
- Invasive BP monitoring if on vasopressors
- Central venous access for CVP, ScvO2
- Point-of-care echo to assess cardiac function
09Decision Assess Shock Phenotype
Warm vs Cold Shock
- WARM shock: Bounding pulses, flash cap refill, wide pulse pressure
- → Norepinephrine preferred
- COLD shock: Weak pulses, prolonged cap refill, narrow pulse pressure
- → Epinephrine preferred
10Action Catecholamine-Resistant Shock
Consider additional therapies
- Add second vasopressor/inotrope
- Consider hydrocortisone if adrenal insufficiency suspected
- Stress-dose steroids: Hydrocortisone 1-2 mg/kg (max 100mg) q6-8h
- Consider ECMO if available and appropriate
- Reassess source control - drainage of abscess?
- Path rejoins step 06Shared downstream outcome
- Path rejoins step 06Shared downstream outcome
11Warning Source Control
Identify and control infection source
- Surgical consultation if needed
- Drain abscesses, debride necrotic tissue
- Remove infected devices/lines
- De-escalate antibiotics when culture data available
Guideline Source
Surviving Sepsis Campaign International Guidelines for Pediatric Septic Shock 2020 + Phoenix Criteria 2024
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Requires clinical judgment for fluid-refractory shock
- Phoenix criteria validated for PICU, may vary in ED
- Does not address source control in detail
- Immunocompromised patients may need modified approach
Applicable Regions
USEU
Version 1Next review: 2027-01-11
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Related Resources
Frequently Asked Questions
What is the Pediatric Sepsis and Septic Shock (SSC/Phoenix 2024)?
The Pediatric Sepsis and Septic Shock (SSC/Phoenix 2024) is a emergency clinical algorithm for Pediatrics. It provides a structured decision tree to guide clinical decision-making, based on Surviving Sepsis Campaign International Guidelines for Pediatric Septic Shock 2020 + Phoenix Criteria 2024.
What guideline is the Pediatric Sepsis and Septic Shock (SSC/Phoenix 2024) based on?
This algorithm is based on Surviving Sepsis Campaign International Guidelines for Pediatric Septic Shock 2020 + Phoenix Criteria 2024 (DOI: 10.1007/s00134-019-05878-6).
What are the limitations of the Pediatric Sepsis and Septic Shock (SSC/Phoenix 2024)?
Known limitations include: Requires clinical judgment for fluid-refractory shock; Phoenix criteria validated for PICU, may vary in ED; Does not address source control in detail; Immunocompromised patients may need modified approach. Individual patient factors may require deviation from these recommendations.
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