Emergency Treatment of Severely Burned Pediatric Patients: Current Therapeutic Strategies

Gerd G. Gauglitz; David N. Herndon; Marc G. Jeschke

Disclosures

Pediatr Health. 2008;2(6):761-775. 

In This Article

Sepsis

Sepsis is one of the leading causes of morbidity and mortality in critically ill patients.[34] Severely burned patients are markedly susceptible to a variety of infectious complications.[35] There are excellent criteria (fever, tachycardia, tachypnea and leukocytosis) for the diagnosis of infection and sepsis in most patients. However, the standard diagnoses for infection and sepsis do not really apply to burn patients, since these patients, according to the definitions of the ABA Consensus Conference to Define Sepsis and Infection in Burns, already suffer from a systemic inflammatory response syndrome (SIRS) due to their extensive burn wounds.[36] Consequently, experts in the field of burn care and/or research establish definitions and guidelines for the diagnosis and treatments of wound infection and sepsis in burns ( Box 1 ). However, it is important to realize that these definitions are sensitive, but not specific, screening tools that should be primarily used for research purposes, and any direct application to the clinical setting must take into account the dynamic and continuous nature of the sepsis disease process and thestatic and categorical nature of the definitions. In addition, clinical parameters used to define SIRS and organ dysfunction are greatly affected by the normal physiologic changes that occur as children develop.[37] A description of pediatric-specific definitions for SIRS, sepsis, severe sepsis and septic shock based on age-specific risks for invasive infections, age-specific antibiotic treatment recommendations and developmental cardiorespiratory physiologic changes has been recently published by Goldstein and colleagues.[38]

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