Initial fluid resuscitation for children with severe sepsis or septic shock who are managed in resource-limited settings

This algorithm summarizes guidance on initial fluid resuscitation during the first hour in pediatric patients with severe sepsis or septic shock who are cared for in regions where access to advanced pediatric critical care and trained critical care personnel is variable or not available. These regions are most common in low- and low-middle income settings. According to the WHO definitions, children with severe sepsis and septic shock are those who present with fever plus signs of circulatory impairment or shock as outlined in the figure above. Fluid resuscitation should be titrated to effect and discontinued if the patient develops clinical signs of fluid overload (eg, tachypnea and/or increased work of breathing with crackles on lung examination, hypoxemia, gallop cardiac rhythm, hepatomegaly, jugular venous distension, and/or cardiomegaly on chest radiograph [if available]). Refer to UpToDate's topics on treatment of pediatric shock in resource-limited settings for additional details, including including guidance for ongoing fluid administration and a discussion of the evidence supporting our approach.