Defining pediatric sepsis by different criteria: discrepancies in populations and implications for clinical practice

Weiss S, Parker B, Bullock M, Swartz S, Price C, Wainwright M, Goodman D. Pediatr Crit Med. 2012;13(4):e219-e226.

The researchers' objectives of this study were to quantify the extent of agreement among different criteria for pediatric severe sepsis/septic shock and to detect systematic differences between those cohorts. The diagnosis of pediatric sepsis is based on clinical and laboratory abnormalities, but different criteria are used to identify children with sepsis for clinical, research, and administrative purposes.

The authors used an observational cohort study at a 42-bed pediatric intensive care unit at an academic medical center with n = 1729 patients 18 years or younger from May 2009 to June 2010. The patients were evaluated for severe sepsis or septic shock on criteria outlined from the International Consensus Conference on Pediatric Sepsis, diagnosis by healthcare professionals, and International Classifications of Diseases.

The authors concluded that research, clinical, and administrative criteria found similar incidence for severe pediatric sepsis/severe shock; there was a moderate level of agreement in patients identified by different criteria, and one-third of patients with a diagnosis of clinical sepsis would not have been included in studies and that differences in patient selection need to be considered when extrapolating data across settings.

Non-invasive ventilation on a pediatric intensive care unit: feasibility, efficacy, and predictors of success

Dohna-Schwake C, Stehling F, Tschiedel E, Wallot M, Mellies U. Pediatr Pulmonol. 2011;46:1114-1120.

Noninvasive ventilation (NIV) has become the criterion standard of treatment of chronic respiratory failure in children, but the authors state there are sparse data on the use of NIV for children with acute respiratory failure. The authors cite that the advantages of NIV include lower risk of ventilator-associated pneumonia, the possibility of the patient to communicate, and not requiring deep sedation. The authors also state that the timing to stop NIV and start invasive ventilation remains unclear. The authors conducted a retrospective chart review with the focus on outcome (intubation and mortality) of these patients and on potential predictors for failure of NIV.

Medical records of all patients treated with NIV in an 8-bed PICU between January 2003 and March 2010 (n = 74) were reviewed, and patients were divided into 6 groups related to underlying diagnosis. Patients who required intubation within the first 2 hours of NIV were defined as early NIV failure. Patients' respiratory status was assessed by blood gas analysis, respiratory rate, oxygen demand, oxygen saturation, and hear rate. Data were obtained prior to initiation of NIV, 1 to 2 hours after initiation, and 8 to 10 hours after initiation.

Of the 74 charts reviewed with patients treated with NIV, 1 patient did not tolerate mask ventilation and required immediate intubation. Intubation rate for the other patients was 23%, and mortality was 15%.The authors found that low pH 1 to 2 hours after initiation of NIV was associated with NIV failure. The authors concluded that NIV can be effective in the treatment of acute respiratory failure.