Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Pathophysiology of Pediatric Sepsis

Video Transcription

Video Summary

Dr. Scott Weiss, a pediatric intensivist, has presented a lecture on the pathophysiology of pediatric sepsis. Sepsis is a spectrum of responses to infection that includes inflammation, abnormal perfusion, and organ dysfunction. It is not a diagnosis itself, but rather a syndrome that involves an underlying infection. The consensus criteria for sepsis include systemic inflammatory response syndrome (SIRS) with infection. Severe sepsis is when organ dysfunction develops, while septic shock includes cardiovascular dysfunction. In pediatrics, shock does not necessarily mean hypotension, but rather abnormal perfusion. Gram-positive and gram-negative bacteria are common causes of sepsis in children, and the site of infection can vary. The presence of bacteremia is helpful, but the absence does not exclude the diagnosis of sepsis. About 30-60% of children with sepsis or septic shock have a positive blood culture. Organ dysfunction in sepsis can involve cardiovascular, respiratory, neurologic, hematologic, renal, and hepatic systems. Multiple organ dysfunction syndrome (MODS) is the accumulation of dysfunctions in multiple organ systems, and it is often present early in children with sepsis. The number of organ dysfunctions is a primary risk factor for death in pediatric sepsis. The outcomes of pediatric sepsis vary, with mortality ranging from 3-6% in all children and up to 25% in PICU patients. Some survivors may have functional disability and are at risk for recurrent infections. Children with sepsis can die from refractory shock or develop chronic MODS. Risk factors for death include comorbid conditions, hospital-acquired sepsis, worsening fluid overload, extremes of age, and number of organ dysfunctions. The pathophysiology of sepsis involves innate and adaptive immunity, cytokines and chemokines, coagulation abnormalities, endothelial dysfunction, macrocirculation dysfunction, microcirculation dysfunction, and mitochondrial dysfunction. The imbalance between pro-inflammatory and anti-inflammatory responses is an important aspect of sepsis. Understanding the pathophysiology can help improve diagnosis and treatment of pediatric sepsis.

Keywords

pediatric sepsis

pathophysiology

inflammation

organ dysfunction

septic shock

bacteremia

multiple organ dysfunction syndrome

mortality rates

risk factors

immune response

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