ICU Pathway for the Evaluation/Treatment of Infants > 28 Days
and Children with Severe Sepsis/Septic Shock

Adjuvant Therapies

IVIG

Primary Humoral Immunodeficiency

Consider polyclonal preparation of IVIG for patients with septic shock

Toxic Shock

Off-label use of IVIG, some data from largely retrospective studies show benefit in mortality1.

Plasma Exchange

If plasma exchange is considered, it has shown the most benefit when performed early (i.e. within 30 hours) after sepsis and organ dysfunction onset.

May be considered for patients with:

Oncology patients who have undergone bone marrow transplant appear to be at increased risk of mortality compared to oncology patients without bone marrow transplant. Neutropenia alone does not appear to increase the risk of mortality from septic shock3. Plasma exchange should be discussed with the primary consulting service (e.g. Oncology or Immunology or Solid Organ Transplant team) for immunosuppressed patients.

Diuresis

Evaluate % fluid overload (FO) daily:

Hemodynamically stable patients with > 10-15% fluid overload, consider diuretic use2:

Consult nephrology if:

Renal Replacement Therapies

Consider use in hemodynamically stable patients with oliguria/anuria and fluid overload unresponsive to diuretic therapy.