SSC 2020 Pediatric Sepsis Algorithms | Nelson Pediatrics

📋 Fig 85.2 — Initial Resuscitation Algorithm for Children (SSC 2020)

🚨 1-Hour Bundle · Recognition to Resuscitation

1. Recognize septic shock (hypotension or perfusion abnormality)

WITHIN 1 HOUR:

▸ Obtain IV/IO access

▸ Collect blood culture (before antibiotics)

▸ Administer broad-spectrum antibiotics

▸ Measure blood lactate

▸ Administer crystalloid fluid bolus (10-20 mL/kg) — titrate to response

▸ Initiate vasoactive medications if shock persists despite fluid therapy

└─ For children in settings with intensive care (local or via transport): fluid bolus up to 40-60 mL/kg in first hour

└─ For children in settings without intensive care access: avoid large fluid boluses unless hypotensive; start maintenance fluids

Continuously reassess: heart rate, perfusion, blood pressure, urine output, lactate

📋 Fig 85.3 — Fluid and Vasoactive-Inotrope Management Algorithm (SSC 2020)

Shock persists after initial fluid bolus(es)?

└─ YES → Fluid-Refractory Septic Shock

▸ Continue fluid boluses (10-20 mL/kg) up to 40-60 mL/kg total in first hour (in ICU-access settings)

▸ Start vasoactive infusion via central line (or peripheral/IO if central not yet available)

└─ Cold shock (poor perfusion, cool extremities, delayed capillary refill) → Epinephrine 0.05-2 mcg/kg/min

└─ Warm shock (flushed, warm extremities, bounding pulses) → Norepinephrine 0.05-2 mcg/kg/min

▸ If shock persists → escalate vasoactive dose, add second agent

└─ Catecholamine-resistant shock → consider hydrocortisone (if adrenal insufficiency), add vasopressin, consider ECPR/ECMO

Continuously reassess: titrate fluids/vasoactives to normalize perfusion, BP, lactate clearance