Paediatrics: how to manage septic shock

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Background: Septic shock is a common critical illness associated with high morbidity and mortality in children. This article provides an updated narrative review on the management of septic shock in paediatric practice.

Methods: A PubMed search was performed using the following Medical Subject Headings: “sepsis”, “septic shock” and “systemic inflammatory response syndrome”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies and reviews. The search was limited to the English literature and specific to children.

Results: Septic shock is associated with high mortality and morbidity. The outcome can be improved if the diagnosis is made promptly and treatment initiated without delay. Early treatment with antimicrobial therapy, fluid therapy and vasoactive medications, and rapid recognition of the source of sepsis and control are the key recommendations from paediatric sepsis management guidelines.

Conclusion: Most of the current paediatric sepsis guideline recommendations are based on the adult population; therefore, the research gaps in paediatric sepsis management should be addressed.

Keywords: antibiotics, critical care, inotropes, intensive care, lactate, organ dysfunction, paediatrics, sepsis, septic shock, systemic inflammatory response syndrome.

Citation: Hon KL, Leung KKY, Oberender F, Leung AKC. Paediatrics: how to manage septic shock. Drugs in Context 2021; 10: 2021-1-5. DOI: 10.7573/dic.2021-1-5

Contributions: KLH is the principal author. AKCL is a co-author who contributed and helped with the drafting of this manuscript. KKYL and FO reviewed the manuscript. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: AKCL and KLH are associate editors of Drugs in Context and confirm that this article has no other conflicts of interest otherwise. This manuscript was sent out for independent peer review by the Managing Editor. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at:

Acknowledgements: None.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2021 Hon KL, Leung KKY, Oberender F, Leung AKC. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2021 Hon KL, Leung KKY, Oberender F, Leung AKC. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

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Correspondence: Kam Lun Hon, Department of Paediatrics and Adolescent Medicine, The Hong Kong Children’s Hospital, Hong Kong. Email:

Provenance: Invited; externally peer reviewed.

Submitted: 12 January 2020; Accepted: 22 March 2021; Publication date: 1 June 2021.

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