Sepsis Bundle Adherence and Early Vasopressor Administration in Pediatric Septic Shock: Secondary Analysis of Outcomes in a 2023 Multicenter Cohort in Bolivia
Abstract
OBJECTIVES
In a cohort of children with septic shock, we evaluated the association between vasoactive agent use within 1 hour of starting our sepsis bundle and mortality. Secondarily, we assessed the relationship between sepsis bundle adherence and mortality and other outcomes.
DESIGN
Nonpreplanned, secondary analysis of a national multicenter dataset collected in a resource-limited setting.
SETTING
Dataset from 14 centers in Bolivia collected between January 2023 and December 2023.
PATIENTS
Children under 15 years old with sepsis or septic shock defined using altitude-adjusted Phoenix criteria.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
We included 268 patients in this secondary analysis, with median (interquartile range [IQR]) age 17 months (IQR, 6-63 mo). The sepsis bundle was used within 3 hours in 131 of 268 patients (49%). Vasopressors were used in 102 of 268 patients (38%) and 85 of 102 (83%) had received peripheral administration within the 1 hour of persistent hypotension, without any record of adverse events. Early vasopressor use within 1 hour of septic shock recognition, and antibiotic administration within 1 hour of sepsis recognition, were independently associated with lower odds (using adjusted odds ratio [aOR] and 95% CI) of mortality, respectively: 0.49 (95% CI, 0.28-0.89) and 0.41 (95% CI, 0.24-0.71; both p = 0.001). Failure to complete the sepsis bundle within 3 hours was associated with greater odds of mortality (aOR, 3.61 [95% CI, 1.64-7.91]; p =…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 268 participants or records.
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