Minerva pediatrica
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The pediatric sepsis syndrome remains a common cause of morbidity, mortality, and health care utilization costs worldwide. The initial resuscitation and management of pediatric sepsis is focused on 1) rapid recognition of abnormal tissue perfusion and restoration of adequate cardiovascular function; 2) eradication of the inciting invasive infection, including prompt administration of empiric broad-spectrum antimicrobial medications; and 3) supportive care of organ system dysfunction. Efforts to improve early and aggressive initial resuscitation and ongoing management strategies have improved outcomes in pediatric severe sepsis and septic shock, though many questions still remain as to the optimal therapeutic strategies for many patients. In this article, we will briefly review the definitions, epidemiology, clinical manifestations, and pathophysiology of sepsis and provide an extensive overview of both current and novel therapeutic strategies used to resuscitate and manage pediatric patients with severe sepsis and septic shock.
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Renal replacement therapy (RRT) is the most effective way of managing severe acute kidney injury (AKI) in critically ill patients. RRT application in children is currently increasing due to the progressive rise of severity of critical illness in these patients. The burden of mortality in RRT children with AKI significantly outweights 50% of the dialized patients (depending also on the diagnosis and on the presence of multiple organ dysfunction). ⋯ Whereas much of the clinical information applied to the adult patients is commonly reported to pediatric critically ill children, recently a significant evolution of RRT technology and novel research on pediatric dialysis warranted interesting evidence and important innovation in this field. In particular, it is currently a matter of debate how pediatric dialysis should be prescribed, when it is indicated and which modality should be utilized. This review will describe different modalities currently available for pediatric RRT, the main mechanisms of solute and water removal, standard and innovative technology specifically relased for neonatal dialysis, the most common prescriptions applicable to dialized children, indications to start and stop RRT.