In this World Shared Practice Forum podcast, Drs. Suchitra Ranjit and Luregn Schlapbach, discuss a framework to provide individualized hemodynamic support for pediatric patients with septic shock, especially those in lower and middle-income countries. The authors discuss considerations described in their expert group's recent article, including how to administer and assess the response of various therapies such as fluids, inotropes, and pressors. LEARNING OBJECTIVES By the end of this podcast, learners will be able to: - Describe the challenges to the early recognition of septic shock in children through a global lens - Introduce the concepts of flow, pressure, and filling in the context of septic shock and their clinical application - Discuss the individualized approach to fluid use in the treatment of septic shock in pediatric patients - Review the literature surrounding the use of fluids in pediatrics and adults AUTHORS Suchitra Ranjit, MD Chief, Pediatric Intensive Care Unit Apollo Children's Hospital, Chennai, India Luregn Schlapbach, Prof, MD, PhD, FCICM Head, Department of Intensive Care and Neonatology University Children`s Hospital Zurich, Switzerland DATES: Initial publication: August 22, 2023 CITATION: Ranjit S, Schlapbach LJ, O’Hara JE, Wolbrink TA. Individualized Hemodynamic Support for Pediatric Patients with Septic Shock. 08/2023. OPENPediatrics. Online Podcast. YT: https://youtu.be/AK6Uz_hZ_SY SC: https://soundcloud.com/openpediatrics/individualized-hemodynamic-support-for-pediatric-patients-with-septic-shock. ARTICLED REFERENCED: - Ranjit S, Kissoon N, Argent A, et al. Haemodynamic support for paediatric septic shock: a global perspective. Lancet Child Adolesc Health. 2023;7(8):588-598. doi:10.1016/S2352-4642(23)00103-7 - Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med. 2018;6(3):223-230. doi:10.1016/S2213-2600(18)30063-8 (1:15) - Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection. N Engl J Med. 2011;364(26):2483-2495. doi:10.1056/NEJMoa1101549 (4:58) - Gu W, Deng X, Lee M, et al. Rapid pathogen detection by metagenomic next-generation sequencing of infected body fluids. Nat Med. 2021;27(1):115-124. doi:10.1038/s41591-020-1105-z (14:02) - Meyhoff TS, Hjortrup PB, Wetterslev J, et al. Restriction of Intravenous Fluid in ICU Patients with Septic Shock. N Engl J Med. 2022;386(26):2459-2470. doi:10.1056/NEJMoa2202707 (24:50) - National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network, Shapiro NI, Douglas IS, et al. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med. 2023;388(6):499-510. doi:10.1056/NEJMoa2212663 (24:52) Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu