Poster ID: 642. Septic shock protocol stressing aggressive fluid resuscitation decreases mortality of children with sepsis in a resource-limited setting Authors: Yos Pagnarith, Varun Kumar, Ngoun Chanpheaktra, Jason Reynolds Angkor Hospital for Children, P.O. Box 50, Siem Reap, CAMBODIA.
Septic shock protocol stressing aggressive fluid resuscitation decreases mortality of children with sepsis in a resource-limited settingAuthors: Yos Pagnarith, Varun Kumar, Ngoun Chanpheaktra, Jason Reynolds Angkor Hospital for Children, P.O. Box 50, Siem Reap, CAMBODIA
Results: In 2005 and 2006, 53 and 98 patients were admitted respectively with a diagnosis of sepsis. In 2005, there was no standardized treatment of septic shock and fluid resuscitation often consisted of 10-20 ml/kg given over 1 hour. In 2006, the septic shock protocol was followed for treatment of all cases with this diagnosis. Compared to 2005, sepsis mortality in 2006 decreased by 40%; from 47% mortality in 2005 to 28% mortality in 2006.
Background: Sepsis is a leading cause of mortality in the developing world. In many of these areas, there seems to be a hesitation regarding the use of aggressive fluid boluses due to excessive fears about fluid overload. These fears are based on the relatively high incidence in the developing world of malnutrition, heart failure, dengue fever, and other diseases which can increase the risk of fluid overload.
Purpose: decrease the mortality of children presenting with septic shock to the PICU at Angkor Hospital for Children in Siem Reap, Cambodia
Hypothesis: A septic shock protocol which emphasizes aggressive fluid resuscitation of up to 60 ml/kg in the first 15 minutes will reduce mortality in critically ill patients with a diagnosis of septic shock who present to the Angkor Hospital for Children in Cambodia.
Methods: The ICU patient log book was reviewed for the year 2005 and all patients were placed in a database according to diagnosis and mortality. The available evidence was reviewed and a protocol for treatment of septic shock was developed by the local Cambodian staff through a process of journal club review and senior medical staff meetings. This protocol was adapted from the algorithm outlined by Carcillo and Fields in Critical Care Med 2002 Vol. 30 (6). The protocol was implemented in January 2006 and data was collected prospectively on diagnosis and mortality.
Conclusion: A septic shock protocol which highlights early and aggressive fluid resuscitation improves mortality in patients with a diagnosis of sepsis presenting to a hospital in a resource-poor setting.
Background of Angkor Hospital for Children (AHC)
AHC is a privately-funded pediatric facility that serves as the provincial referral medical center for children aged birth to 15 years for Siem Reap Province in Cambodia. All care at AHC is provided free of charge. AHC also serves as a pediatric training center for Cambodian health professionals. 98% of the staff at AHC is Cambodian.
To learn more about our hospital, please visit : www.angkorhospital.org