ICU Pathway for the Evaluation/Treatment of Infants > 28 Days
and Children with Severe Sepsis/Septic Shock
Related Pathway:
ED Severe
Sepsis Pathway
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MD/CRNP/RN Rapid Assessment
If > 40 mL/kg, order dopamine to bedside
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FLUID REFRACTORY SHOCK
Consider CVL, Arterial line, Foley
20 min
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45-60 min
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1-6 hrs
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PICU Discharge
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WARM SHOCK

  • Titrate dopamine, norepinephrine
  • Consider epinephrine, vasopressin
  • PRBC if Hgb < 10 g/dL
  • Consider ETT

COLD SHOCK - LOW BP

COLD SHOCK – NORMAL BP

  • Titrate dopamine, epinephrine
  • Consider milrinone or dobutamine if
    (ScvO2 < 70% or lactate elevated)
  • PRBC if Hgb < 10 g/dL
  • Consider BNP, ECHO, ETT
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Give stress-dose hydrocortisone
Evaluate for:
  • Pericardial Effusion
  • Pneumothorax
  • Intra Abdominal Hypertension
  • Primary cardiac dysfunction
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ECMO
Adjuvant Therapies
IVIG, Plasma Exchange, Diuresis, RRT
Nutrition
1st 24 hrs, > 24 hrs
Continue to Monitor Clinical Goals Following Resolution of Shock
Posted: August 2012
Authors: J. Fitzgerald, MD, S. Weiss, MD, L. Marsillio, MD, C. Watson, RN, S. Warrington, Pharm D., R. Giordano, RT, T. Metjian, Pharm D., K. Chiotos, MD, J. Verger, RN, B. Laskin, MD, J. Rossano, MD, K. Roberts, CNS, V. Srinivasan, MD J. Gerber, MD, G. Bird, MD