Critical Connections

Critical Connections, the critical care industry's only newsmagazine, provides information on cutting-edge topics in critical care useful to the entire multiprofessional team. With features written by and for critical care professionals, updates on SCCM activities and programs, Critical Connections is a vital source of information for the critical care community.

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Critical Connections Spring 2020 Sepsis and Children	Critical Connections Summer 2020 COVID-19: Rising to the Challenge

The Spring issue of Critical Connections featured an article on the new Surviving Sepsis Campaign (SSC) Pediatric Sepsis Guidelines that included potentially misleading information regarding the delivery of bolus fluid in the first hour of treatment. To ensure accuracy and clarity, the statement on page 9 should read as follows:

Children who are being treated in healthcare systems where intensive care is available (on site or through transport) should be provided up to 40-60 mL/kg bolus fluid in the first hour of treatment, based on cardiac output and discontinued if they exhibit signs of fluid overload. However, healthcare systems where intensive care is not available or accessible may not have the resources to manage fluid overload and therefore should not administer a bolus of fluid (unless the child has extremely low blood pressure) and instead provide maintenance fluid.
In other words, as long as there is ICU capability – where fluid overload can be managed if it occurs – the SSC suggests that children receive bolus fluid in the first hour.

The previous version noted that health systems without ICUs should not provide bolus fluid because they may not have the resources to assess and manage fluid overload. This direction is not applicable in settings where community hospitals without ICUs can readily transfer children to larger hospitals that offer that level of care or in settings where advanced hemodynamic and respiratory care can be provided outside of a formal ICU. Simply put, if intensive care is accessible (even if not on site), the SSC suggests the child be provided up to 40-60 mL/kg bolus fluid in the first hour of treatment, based on cardiac output and discontinued if they exhibit signs of fluid overload.

Critical Connections Latest Articles

How a Master of Critical Care Medicine Prepared for the Coronavirus Pandemic
Philip S. Barie, MD, MBA, MCCM, discusses how him and his team prepared for the COVID-19 pandemic.

How SCCM’s FDM Course Helped One New York City Hospital Address the Pandemic
Richard H. Savel, MD, CPE, FCCM, shares his story on how SCCM's FDM course helped prepare for the pandemic.

President's Message: Triumph Amidst Crisis
SCCM President Lewis J. Kaplan, MD, FACS, FCCP, FCCM, discusses how SCCM and its members embraced new approaches and drove innovative means of patient rescue.

Applying the ICU Liberation Bundle to Critically Ill Children
The aim of this article is to provide pediatric intensive care unit (PICU) practitioners with general guidance on implementation of the ICU Liberation Bundle.

Disparities in Sepsis Management and Outcomes
This article explores the disparities found among different patient populations diagnosed with sepsis.

Pediatric Septic Shock and Requests for Potentially Inappropriate Treatments
Explore this ethics case and case analysis that covers pediatric septic shock and requests for portentially inappropriate treatments from family.

Scvo2 in Sepsis: A Measurement Provided by Respiratory Care Practitioners
This article outlines the value of central venous oxygen saturation (Scvo2) measurement in sepsis patients, emphasizing the role of the respiratory care practitioner in measuring Scvo2 using blood gas oximetry.

Surviving Sepsis Campaign Releases First Guidelines for Sepsis in Children
The Surviving Sepsis Campaign (SSC) released its first guidelines for pediatric patints with sepsis in February. More than 1.2 million children develop sepsis globally every year, including more than 75,000 in the United States.

President’s Message: Enhancing Society Flexibility by Tapping a KEG
SCCM President Lewis J. Kaplan, MD, FACS, FCCP, FCCM, discusses how SCCM can tap into Knowledge Education Groups to engage with members and meet their needs.

Stop My Dad’s Suffering: Bridging the Gap Between Comfort Care and Euthanasia
Review this case study and analysis about bridging the gap between comfort care and euthanasia.

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Individual articles may be distributed as a PDF upon request. For permission to reprint articles in other materials or to request additional copies of Critical Connections, contact Melissa Nielsen. A $1 per issue charge plus shipping fees may be applied to bulk requests.