An international pediatric sepsis consensus conference reported criteria cardiovascular dysfunction associated with sepsis.
Patient selection: assessment after fluid resuscitation (>= 40 mL per kg of isotonic fluid IV in first hour)
Parameters:
(1) blood pressure
(2) need for vasoactive drugs to maintain blood pressure
(3) base deficit and unexplained metabolic acidosis
(4) arterial blood lactate concentration
(5) urine output
(6) capillary refill in seconds
(7) gap between core and peripheral temperatures in °C
Blood Pressure
Hypotension - one of the following:
(1) blood pressure < 5th percentile for age
(2) systolic blood pressure < 2 SD below mean for age
|
Age |
Abnormal SBP |
|
<= 7 days |
< 65 mm Hg |
|
8 to 30 days |
< 75 mm Hg |
|
1 to 12 months |
< 100 mm Hg |
|
2 to 5 years |
< 94 mm Hg |
|
6 to 12 years |
< 105 mm Hg |
|
13 to 17.99 years |
< 117 mm Hg |
Vasoactive Drugs
|
Parameter |
Finding |
Points |
|
dopamine |
< 5 µg/kg/min |
0 |
|
|
> 5 µg/kg/min |
1 |
|
dobutamine |
none |
0 |
|
|
any dose |
1 |
|
epinephrine |
none |
0 |
|
|
any dose |
1 |
|
norepinephrine |
none |
0 |
|
|
any dose |
1 |
Other Parameters
|
Parameter |
Finding |
Points |
|
base deficit |
<= 5 mEq/L |
0 |
|
|
> 5 mEq/L |
1 |
|
blood lactate |
<= 2 times ULN |
0 |
|
|
> 2 times ULN |
1 |
|
urine output |
>= 0.5 mL per kg per h |
0 |
|
|
< 0.5 mL per kg per h |
1 |
|
capillary refill |
<= 5 seconds |
0 |
|
|
> 5 seconds |
1 |
|
temperature gap |
<= 3 °C |
0 |
|
|
> 3°C |
1 |
score for other parameters =
= SUM(points for the 5 parameters)
Criteria for cardiovascular dysfunction - one or more of the following:
(1) hypotension
(2) >=1 point for vasoactive drugs
(3) >= 2 points for the other parameters
Specialty: Critical Care, Infectious Diseases
