Well, we slowly start with introduction. Good morning, everyone. My name is Lorenz Lapoch, and it's my absolute pleasure, together with co-chair Scott Watson, on behalf of the entire Pediatric Sepsis Definitions Task Force, sponsored by SCCM, to present the novel Phoenix criteria for sepsis in children. This is a truly exciting moment for us after many years of work, and we feel immensely humbled and fortunate to have been part of such a magnificent group of researchers and colleagues. These are disclosures, and we would like to acknowledge the vision and leadership from SCCM to have funded this work strongly, as well, you know, mentored in the beginning through Jared Zimmerman, who can't be here today, and Tex Kissoon. So when we think about the burden of pediatric sepsis, as shown in the Lancet Global Burden of Disease paper, roughly half of worldwide sepsis cases affect pediatric age groups. And this leads to about three million deaths every year. As you can see here, the majority of those affect children that are less than five years of age. So these children have not only different epidemiology, but they have, as well, different comorbidities, different immune systems, different developmental characteristics, and even different outcomes to adults with sepsis. And this makes it so necessary that we actually derive and validate the pediatric sepsis criteria based on pediatric cohorts. And as we all know, you know, sepsis is essentially at the beginning of life, in the first few years of life, has an impact which goes way beyond mortality. Children with sepsis, even if they survive, they may suffer from sometimes lifelong sequelae across a range of core outcome sets. And so this leads to a magnified whole of society impact for many decades to come. And as we all know, when we mean sepsis, at present, one of the challenges has been that pediatricians mean very, very different things. The intensivist actually sees more, you know, children at the right end of the spectrum where multi-organ dysfunction actually is visible. The big challenge is that in pediatrics, where a lot of viral infections predominate, there's a funnel that's extremely challenging, in particular for ED and general practice setting, which are confronted to many, many children with fever and flu. And so in this zone between balancing sensitivity and specificity, there is actually a sweet spot where we have criteria for a disease that are specific, that are useful, but as well, you know, sensitive enough to capture children who are at high risk of a poor outcome. And of course, such criteria are important as well for the future, because these criteria and the timing of those relates as well to the likelihood that the patient may benefit or be responsive to certain interventions. The problem in this field has been that for pretty much 20 years, there's been criteria for pediatric sepsis which were not based on data, which were eminence-based and crafted actually to allow enrollment in the RESOLVE trial back on then. And not only have they not been validated, but the limitations of using SIRS as a criteria on for sepsis has been highlighted in adults and in children in a number of studies. And it's becoming increasingly clear that SIRS criteria are actually probably more adaptive rather than maladaptive processes. But the way the 2005 criteria have been used across the world was so variable that it has actually impacted consistent and comparable use, for example, impacting on how we measure sepsis around the world. And from this perspective, actually, the crafting of sepsis 3 in 2016 that we released in JAMA was a major step forward using data-driven approaches actually coupled with systematic reviews and consensus criteria. However, as the authors stated explicitly, these criteria were neither designed nor derived nor actually properly validated for children, leaving a real gap. In addition as well, sepsis 3 was based on units in the United States and in Germany, and so there was no contribution of lesser-resourced settings actually to the data. And the score used, the SOFA score, has been pre-existing, and to this date actually we do not know if this was sort of the best type of score adaptation for that topic. And finally as well, the shock criteria used criteria which were partially different actually from the criteria used actually within the sepsis score. And so with these considerations in mind, we've embarked on the process to derive and validate novel criteria for sepsis in children, and my co-chair Scott Watson is going to give you a brief overview of the work done in the past years. Thank you.

Phoenix criteria

pediatric sepsis

Pediatric Sepsis Definitions Task Force

SCCM

sepsis diagnosis