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reversal was titrated to central venous pressure (CVP) and ScvO2 or hypotension/shock index reversal Pediatric studies have also demonstrated improved survival with timely fluid resuscitation, and continuous monitoring of ScvO2 Recent data from New York State demonstrated that completion of a 1hour bundle of blood cultures, broad-spectrum antibiotics, and a 20-mL/kg IV fluid bolus was associated with a lower risk-adjusted odds of hospital mortality in children with sepsis and septic shock (aOR 0.59, 95% CI 0.38–0.93) There is increasing interest in definitively answering questions about both appropriate volume and type of crystalloid fluid resuscitation in pediatric sepsis, and several ongoing clinical trials are attempting to answer these questions Global Considerations The efficacy of fluid resuscitation in pediatric sepsis has been questioned in the FEAST trial which demonstrated increased mortality in children with septic shock who received rapid and large-volume fluid resuscitation Several concerns have been raised that these findings were specific to the local host population with a high prevalence of malaria, severe anemia, and low availability of critical care interventions, and also that the definition of shock may differ between this study and others However, this study was a robust trial, and certainly raises the possibility that caution should be taken with fluid resuscitation in certain populations of children with sepsis, especially those with severe anemia and malnutrition American College of Critical Care Medicine and Surviving Sepsis Campaign Recommendations Based on available data, current sepsis guidelines recommend antibiotic administration within hour of recognition of septic shock, as well as prompt fluid resuscitation in adults and children In addition, timely sepsis care has been identified as a quality metric at many pediatric institutions in the United States Several pediatric institutions have successfully implemented protocol-based sepsis care and have demonstrated associated improvements in the delivery of timely sepsis care These improvements have been associated with reduced ICU and hospital length of stay and lower hospital mortality However, although there is clear data outlining poor outcomes with long (>3-hour) antibiotic delays in pediatric sepsis, the importance of the 1-hour cut-point has not been firmly established Quality Metrics in Pediatric Sepsis
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