Summary of the key changes and recommendations from the Surviving Sepsis Campaign (SSC) International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children.

1. Screening and Recognition:

• Systematic Screening: The guidelines recommend implementing automated or manual screening tools in emergency departments and wards to identify patients earlier.
• Lactate: While helpful, lactate levels should not be used as the sole marker for septic shock; clinical assessment (capillary refill, pulses, mental status) remains paramount.

2. Resuscitation (The "First Hour") ⏱️

The guidelines introduced a nuanced approach to fluids based on the availability of intensive care resources.

• Fluid Boluses:

  • Settings WITH Intensive Care: For patients with septic shock, administer 10–20 mL/kg of balanced crystalloids (like Lactated Ringer's) over the first hour.
  • Settings WITHOUT Intensive Care: If the patient is not hypotensive, do not give a fluid bolus initially (maintenance fluids only). If they are hypotensive, give 10–20 mL/kg.
  • Why? This prevents fluid overload in settings where mechanical ventilation and advanced inotropic support aren't readily available to manage complications.

• Access: Intraosseous (IO) access is recommended if IV access is difficult to obtain quickly.

3. Antimicrobial Therapy 💊

• Septic Shock: Start broad-spectrum antibiotics within 1 hour of recognition.
• Sepsis (without shock): If shock is absent, the guidelines allow up to 3 hours to assess and start antibiotics, prioritizing diagnostic evaluation to confirm infection first.

4. Vasoactive Support 

• First Line: Epinephrine or Norepinephrine are now recommended as the first-line vasoactive medications.
• Dopamine: The guidelines explicitly suggest against using Dopamine if Epinephrine or Norepinephrine are available (a major shift from older PALS protocols).