The impact of adherence to the American College of Critical Care Medicine 2017 guidelines in the management of septic shock in pediatric intensive care units: A prospective observational study

Abstract

Background: Despite tremendous advances and new guidelines for the management of pediatric septic shock, the mortality and morbidity associated with it remain unacceptably high. This study was conducted to evaluate the impact of adherence to the American College of Critical Care Medicine (ACCM) guidelines in the management of septic shock in pediatric intensive care units (PICU). Subjects and Methods: This was a hospital-based prospective observational study conducted in the 15-bedded PICU of a tertiary care hospital in Utter Pradesh, India. Children from 1 month to 18 years of age admitted to the PICU with septic shock were included in the study as per definitions given by ACCM guidelines. The children who were managed strictly adhering to ACCM guidelines were labeled as the adherent group and those who were managed with any deviation from these guidelines were considered as the nonadherent group. The two groups were compared with respect to outcome. Results: In this study, the prevalence of septic shock was 54.4% in PICU. Out of 124 cases of septic shock, 93 were from the adherent group and 31 were from the nonadherent group. Recovery was significantly higher (p-0.012) in children among the adherent group (56 [60.21%] vs. 11 [35.48%]) than in the nonadherent group. The hemodynamic stability achieved within 48 h among the adherent group was higher in comparison to the nonadherent group (39 [56%] vs. 6 [8.5%]) making this a significant (P = 0.007) observation. Conclusions: Strict adherence to the ACCM guidelines was associated with favorable outcomes in the management of septic shock in children.