Differentiating between Warm and Cold Shock in Pediatric Sepsis

Scott Weiss, MD is an Associate Professor of Pediatrics and Pathology at Thomas Jefferson University. He serves as the Chair of the Division of Pediatric Critical Care Medicine at Nemours Children’s Hospital in Wilmington, Delaware.  Dr. Weiss’ research focuses on epidemiology of pediatric sepsis and mitochondrial dysfunction in sepsis-associated organ injury. He recently served as the Co-Vice Chair for the international Pediatric Surviving Sepsis Campaign and was first author on the 2020 pediatric sepsis guidelines.

Learning Objectives: 

By the end of this podcast series, listeners should be able to: 

1. Describe the high-quality literature of fluid boluses in the management of pediatric septic shock.
2. Recognize how healthcare settings and resource availability may affect the utility of fluid boluses in select pediatric patients with suspected septic shock.
3. Recall the limitation of the beside assessment to determine if a patient with sepsis is suffering from “cold” or “warm” shock.
4. Describe the role of advanced hemodynamic monitoring in determining a patient's underlying physiology in septic shock.
5. Describe an approach to choosing initial and second-line vasoactive medications in septic shock.
6. Describe the physiologic rationale, evidence, and limitations of targeting a higher hemoglobin threshold for patients with ongoing septic shock. 
7. Describe the physiologic rationale, evidence, and limitations of using a combination of hydrocortisone, ascorbic acid, and thiamine (HAT) in the management of septic shock. 
8. Recognize when VA-ECMO might be indicated in pediatric septic shock.

Reference:

Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, Nadel S, Schlapbach LJ, Tasker RC, Argent AC, Brierley J, Carcillo J, Carrol ED, Carroll CL, Cheifetz IM, Choong K, Cies JJ, Cruz AT, De Luca D, Deep A, Faust SN, De Oliveira CF, Hall MW, Ishimine P, Javouhey E, Joosten KFM, Joshi P, Karam O, Kneyber MCJ, Lemson J, MacLaren G, Mehta NM, Møller MH, Newth CJL, Nguyen TC, Nishisaki A, Nunnally ME, Parker MM, Paul RM, Randolph AG, Ranjit S, Romer LH, Scott HF, Tume LN, Verger JT, Williams EA, Wolf J, Wong HR, Zimmerman JJ, Kissoon N, Tissieres P. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med. 2020 Feb;21(2):e52-e106. doi: 1

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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.