Adherence to the guidelines for the treatment of sepsis in children in pediatric intensive care units

Background. Some studies have demonstrated the relationship between compliance with treatment protocols and outcomes of sepsis in children. Objective. To assess the feasibility of documented treatment of sepsis in ICU children. Material and methods. A retrospective observational multiple-center study included 122 children between June 01, 2022 and December 26, 2022. Inclusion criteria: children aged from 2 months to 18 years, infection confirmed by microbiological data, pSOFA score >2. Septic shock was diagnosed in 31 (25.4%) children, and 37 (30.3%) patients died. The following criteria were used: 1) timing of sepsis detection; 2) period between diagnosis and the first administration of antibacterial drug; 3) period between diagnosis and the first fluid bolus; 4) fluid bolus injection rate and vasopressor support; 5) respiratory support; 6) nutritional support; 7) additional treatment methods. Clinical data are presented in median values. Continuous variables were compared using the Mann-Whitney U-test and χ2 test. Pearson’s C-test was used to assess the relationships between two independent variables. Probability of events was analyzed considering odds ratio. Results. Mean pSOFA score at admission to ICU was 6 points. Sepsis was diagnosed in 5 days after hospitalization and later in dead patients (p<0.001). All basic recommendations were fully implemented in 21 (17.4%) patients. The limiting factor was blood sampling for microbiological analysis before prescribing antibiotics. Compliance with therapeutic protocols was 86.9%. Conclusion. In national intensive care units, adherence to sepsis treatment in children is suboptimal. Shock, anemia (hemoglobin <70 g/l) and delayed (>6 days) admission of children with sepsis to intensive care units are the main risk factors for mortality. A perspective direction to eliminate these determinants in children with sepsis may be clear protocols for diagnosis and treatment of this disease.