The Utilization of the Surviving Sepsis Campaign Care Bundles in the Treatment of Pediatric Patients with Severe Sepsis or Septic Shock in a Resource-Limited Environment: A Prospective Multicenter Trial.

BACKGROUND: Sepsis is a common condition affecting the lives of infants and children worldwide. Although implementation of the surviving sepsis campaign (SSC) care bundles was once believed to be effective in reducing sepsis mortality rates, the approach has recently been questioned. METHODS: The study was a prospective, interventional, multicenter trial. Infants and children aged 1 month to 15 years in seven different large academic centers in Thailand who had been diagnosed with severe sepsis or septic shock. They were given treatment based on the SSC care bundles. RESULTS: A total of 519 children with severe sepsis or septic shock were enrolled in the study. Among these, 188 were assigned to the intervention group and 331 were recruited to the historical case-control group. There were no significant differences in the baseline clinical characteristics. The intervention group was administered a significantly higher fluid bolus than was the control group (28.3 ± 17.2 cc/kg vs. 17.7 ± 10.6 cc/kg; P = 0.02) with early vasopressor used (1.5 ± 0.7 h) compared to control group (7.4 ± 2.4 h, P < 0.05). More importantly, our sepsis mortality reduced significantly from 37% ± 20.7% during the preintervention period to 19.4% ± 14.3% during the postintervention period (P < 0.001). CONCLUSION: Our study demonstrated a significant reduction in sepsis mortality after the implementation of the SSC care bundles. Early diagnosis of the disease, optimum hemodynamic resuscitation, and timely antibiotic administration are the key elements of sepsis management.

Effects of temperature and time delay on arterial blood gas and electrolyte measurements.

OBJECTIVE: To determine the changes in pH, PaO2, PaCO2 and Na, K, Cl in arterial blood samples stored at room temperature or on ice, at 0, 15, 30, 45 and 60 minutes. MATERIAL AND METHOD: Arterial blood samples were collected in heparinized capillary tubes and stored at room temperature (24-26 degrees C) and on ice (0-4 degrees C). ABG and electrolytes were measured at 0, 15, 30, 45 and 60 minute intervals. RESULTS: There were significant decreases in the pH, PaO2, Na, Cl and significant increases in PaCO2 and K over time in both groups. The changes were greater and faster at room temperature. The significant decrease in pH over time was not found until 30 minutes at room temperature and 45 minutes on ice. There were significant decreases in PaO2, concurrent with significant increases in PaCO2 from 15 minutes onwards in both groups. Both Na and K exhibited a significant change at 60 minutes in the room temperature group. Significant decreases of Cl over time were not found until 15 minutes at room temperature, and 30 minutes on ice. CONCLUSION: For ABG and electrolytes analysis, the blood sample should be analyzed within 15 minutes and be stored at either room temperature or on ice.

Mycoplasma pneumonia in young children, 2-5 years of age.

BACKGROUND: Mycoplasma pneumoniae is one of the most common causes of childhood community-acquired pneumonia (CAP), particularly in school-age children. Information regarding this infection in pre-school age children is lacking. OBJECTIVE: To determine the prevalence of M. pneumoniae in young children aged under 5 years with CAP. MATERIAL AND METHOD: This prospective study was conducted at Queen Sirikit National Institute of Child Health (QSNICH), Bangkok, Thailand between December 2001 and November 2002. We enrolled children aged 2 to 5 years with a clinical and radiological diagnosis of CAP. Acute and convalescent sera were collected and measured by using a particle agglutination test. Polymerase chain reaction (PCR) assay for M. pneumoniae was detected from nasopharyngeal secretions. Criteria for diagnosis were defined as > or = 4-found rising of mycoplasma antibody or titer > or = 1:160 with positive PCR. RESULTS: Thirteen out of 113 CAP patients were diagnosed as mycoplasma pneumonia. Three of them were diagnosed by > or = 4-fold rising of mycoplasma antibody while another 10 patients were diagnosed by mycoplasma titer > or = 1:160 with positive PCR for M. pneumoniae. Clinical symptoms and signs of these 13 mycoplasma pneumonia in young patients were fever (85%), cough (92%), dyspnea (85%), diarrhea (15%), rales (85%), wheezing or rhonchi (46%), and skin rash (15%). Leucocytosis (wbc > 15,000/cumm) was found in 46%. Chest x-rays revealed interstitial infiltration (71%), patchy infiltration (29%) and no pleural effusion was detected. Choices of antibiotic were erythromycin (31%), beta lactam antibiotics (61%), and antibiotic was not prescribed in one patient (8%). Sixty-nine percent of the patients improved, while 31% did not, possibly due to the use of beta lactam antibiotics, or non use of antibiotics. CONCLUSION: Mycopalsma pneumonia is not uncommon in children aged 2-5 years with CAP. Clinical signs, symptoms and radiological findings are non-specific and cannot be differentiated from other causes of CAP.