PICU Pathway for the Evaluation/Treatment of Infants > 28 Days
and Children with Severe Sepsis/Septic Shock
No Evidence of Organ Dysfunction
Evidence of Organ Dysfunction
FLUID REFRACTORY SHOCK
Consider CVL, arterial line, Foley
20 min
45-60 min
1-6 hrs
PICU Discharge

WARM SHOCK

  • Titrate norepinephrine
  • Consider epinephrine, dopamine, vasopressin
  • PRBC if Hgb < 8 - 10 g/dL

COLD SHOCK - LOW BP

  • Titrate epinephrine
  • Consider norepinephrine, dopamine, dobutamine
  • PRBC if Hgb < 8 - 10 g/dL

COLD SHOCK – NORMAL BP

  • Titrate epinephrine
  • Consider dopamine
  • Consider milrinone or dobutamine if
    ScvO2 < 70% or lactate elevated
  • PRBC if Hgb < 8 - 10 g/dL
Consider Stress Dose Hydrocortisone
Evaluate for:
  • Pericardial effusion
  • Pneumothorax
  • Intra-abdominal hypertension
  • Primary cardiac dysfunction
Consider ETT
Consider ECMO
Adjuvant Therapies
IVIG, Plasma Exchange, Diuresis, RRT
Continue to Monitor Clinical Goals Following Resolution of Shock
Posted: August 2012
Revised: February 2016, August 2019
Authors: K. Chiotos, MD; J. Fitzgerald, MD; S. Weiss, MD; L. Marsillio, MD; C. Watson, RN; S. Warrington, PharmD; R. Giordano, RT; T. Metjian, PharmD; J. Verger, RN; B. Laskin, MD; J. Rossano, MD; K. Roberts, CNS; V. Srinivasan, MD; J. Gerber, MD; G. Bird, MD; C. Woods-Hill MD; M. Hayes PharmD