Sepsis is a leading cause of morbidity, mortality, and healthcare utilization for children worldwide. Globally, an estimated 22 cases of childhood sepsis per 100,000 person-years and 2,202 cases of neonatal sepsis per 100,000 live births occur, translating into 1.2 million cases of childhood sepsis per year (1). More than 4% of all hospitalized patients less than 18 years and ~8% of patients admitted to PICUs in high-income countries have sepsis (2–6). Mortality for children with sepsis ranges from 4% to as high as 50%, depending on illness severity, risk factors, and geographic location (2, 3, 7–9). The majority of children who die of sepsis suffer from refractory shock and/or multiple organ dysfunction syndrome, with many deaths occurring within the initial 48 to 72 hours of treatment (10–13). Early identification and appropriate resuscitation and management are therefore critical to optimizing outcomes for children with sepsis. In 2001, the Surviving Sepsis Campaign (SSC) was formed by the Society of Critical Care Medicine (SCCM), European Society of Intensive Care Medicine (ESICM), and the International Sepsis Forum. A primary aim of the SSC was to develop evidenced-based guidelines and recommendations for the resuscitation and management of patients with sepsis. The initial guidelines were published in 2004 and have been reviewed and updated every four years thereafter. Following the 2016 edition, SCCM and ESICM reaffirmed their commitment to evidence-based guidelines for all patients by forming separate task forces dedicated to guidelines for adults and children. The objective of the SCCM/ESICM “Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-associated Organ Dysfunction in Children” is to provide guidance for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. We sought to leverage the expertise of a clinical and methodology team to create comprehensive evidence-based recommendations for the recognition and management of children with septic shock or other sepsis-associated acute organ dysfunction. Recommendations from these guidelines are based on the best current evidence but cannot replace the clinician’s decision-making capability when presented with a patient’s unique set of clinical variables. Recommendations are intended to guide “best practice” rather than to establish a treatment algorithm or to define standard of care. These guidelines are appropriate for treating septic shock and other sepsis-associated organ dysfunction in a hospital, emergency, or acute care setting, although some may be applicable elsewhere. Although recommendations were developed without consideration to availability of resources, we acknowledge that variation within and across healthcare systems and geographic regions will determine the practical application of these guidelines. Although several recommendations for the care of children with sepsis and septic shock have been previously published (14–16), these new guidelines are not intended to update or iterate on these prior documents. Instead, it was the aim of SCCM/ESICM “Surviving Sepsis Campaign” to provide an evidence-based approach to the management of septic shock and other sepsis-associated organ dysfunction in children using a comprehensive and transparent methodologic approach by a panel with geographic and professional diversity.
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