• Guillermo A Kohn-Loncarica, Ana L Fustiñana, Roberto M Jabornisky, Sonia V Pavlicich, Javier Prego-Pettit, Adriana Yock-Corrales, Consuelo R Luna-Muñoz, Nils A Casson, Eugenia A Álvarez-Gálvez, Ibelice R Zambrano, Cristina Contreras-Núñez, César M Santos, Guadalupe Paniagua-Lantelli, Camilo E Gutiérrez, Sérgio L Amantea, Sebastián González-Dambrauskas, María José Sánchez, Pedro B Rino, Santiago Mintegi, Niranjan Kissoon, and Red de Investigación y Desarrollo de la Emergencia Pediátrica Latinoamericana (RIDEPLA).
• Unidad Emergencias, Hospital de Pediatría Prof. Dr. Juan P. Garrahan y Universidad de Buenos Aires, Buenos Aires.
• Pediatr Emerg Care. 2021 Nov 1; 37 (11): e757e763e757-e763.

ObjectiveGuidelines adherence in emergency departments (EDs) relies partly on the availability of resources to improve sepsis care and outcomes. Our objective was to assess the management of pediatric septic shock (PSS) in Latin America's EDs and to determine the impact of treatment coordinated by a pediatric emergency specialist (PEMS) versus nonpediatric emergency specialists (NPEMS) on guidelines adherence.MethodsProspective, descriptive, and multicenter study using an electronic survey administered to PEMS and NPEMS who treat PSS in EDs in 14 Latin American countries.ResultsWe distributed 2164 surveys with a response rate of 41.5%, of which 22.5% were PEMS. Overall American College of Critical Care Medicine reported guidelines adherence was as follows: vascular access obtained in 5 minutes, 76%; fluid infusion technique, 60%; administering 40 to 60 mL/kg within 30 minutes, 32%; inotropic infusion by peripheral route, 61%; dopamine or epinephrine in cold shock, 80%; norepinephrine in warm shock, 57%; and antibiotics within 60 minutes, 82%. Between PEMS and NPEMS, the following differences were found: vascular access in 5 minutes, 87.1% versus 72.7% (P < 0.01); fluid infusion technique, 72.3% versus 55.9% (P < 0.01); administering 40 to 60 mL/kg within 30 minutes, 42% versus 29% (P < 0.01); inotropic infusion by peripheral route, 75.7% versus 56.3% (P < 0.01); dopamine or epinephrine in cold shock, 87.1% versus 77.3% (P < 0.05); norepinephrine in warm shock, 67.8% versus 54% (P < 0.01); and antibiotic administration within first 60 minutes, 90.1% versus 79.3% (P < 0.01), respectively. Good adherence criteria were followed by 24%. The main referred barrier for sepsis care was a failure in its recognition, including the lack of triage tools.ConclusionsIn some Latin American countries, there is variability in self-reported adherence to the evidence-based recommendations for the treatment of PSS during the first hour. The coordination by PEMS support greater adherence to these recommendations.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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