Operationalizing Appropriate Sepsis Definitions in Children Worldwide: Considerations for the Pediatric Sepsis Definition Taskforce.
Operationalizing Appropriate Sepsis Definitions in Children Worldwide: Considerations for the Pediatric Sepsis Definition Taskforce.
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DOI：
10.1097/pcc.0000000000003263
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发表时间：
2023-06-01
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脓毒症是全球儿童死亡的主要原因，但儿童脓毒症的定义已经过时，缺乏全球适用性和有效性。在成人中，脓毒症-3定义工作组查询了来自高收入国家的数据库，以制定和验证标准。这一定义的优点已得到广泛承认;然而，关于资源较少和更多样化的环境的重要考虑因素对其全球使用构成了挑战。为了提高全球范围内的适用性和相关性，儿科脓毒症定义工作组试图建立一个概念框架和关键方面的基本原理，以及未来儿科脓毒症定义的最佳操作必须考虑的特定环境因素。重要的是要解决挑战，制定一套儿科败血症标准，捕捉疾病的表现与巨大不同的病因和潜在机制。理想的标准必须是明确的，并且能够适应全球存在疑似感染儿童的不同情况。此外，标准需要促进早期识别和及时升级治疗，以防止进展和限制危及生命的器官功能障碍。为了应对这些挑战，需要有适合当地的解决方案，允许根据可用资源和脓毒症的检测前概率进行个性化护理。这将促进负担得起的诊断，支持风险分层和预测可能的治疗反应，并为当地相关的结果措施提供解决方案。为此，需要建立全球协作数据库，使用常规收集数据的最小变量数据集。总之，需要一种“全球思考，本地行动”的方法。
Sepsis is a leading cause of global mortality in children, yet definitions for pediatric sepsis are outdated and lack global applicability and validity. In adults, the Sepsis-3 Definition Taskforce queried databases from high-income countries to develop and validate the criteria. The merit of this definition has been widely acknowledged; however, important considerations about less-resourced and more diverse settings pose challenges to its use globally. To improve applicability and relevance globally, the Pediatric Sepsis Definition Taskforce sought to develop a conceptual framework and rationale of the critical aspects and context-specific factors that must be considered for the optimal operationalization of future pediatric sepsis definitions. It is important to address challenges in developing a set of pediatric sepsis criteria which capture manifestations of illnesses with vastly different etiologies and underlying mechanisms. Ideal criteria need to be unambiguous, and capable of adapting to the different contexts in which children with suspected infections are present around the globe. Additionally, criteria need to facilitate early recognition and timely escalation of treatment to prevent progression and limit life-threatening organ dysfunction. To address these challenges, locally adaptable solutions are required, which permit individualized care based on available resources and the pretest probability of sepsis. This should facilitate affordable diagnostics which support risk stratification and prediction of likely treatment responses, and solutions for locally relevant outcome measures. For this purpose, global collaborative databases need to be established, using minimum variable datasets from routinely collected data. In summary, a “Think globally, act locally” approach is required.