Background Paediatric sepsis remains an important cause of hospital mortality within the UK and across the globe. ACCM/PALs guidelines recommend rapid fluid resuscitation up to 60mls/kg within an hour where necessary. If this fluid support does not provide a clinical improvement, the patient is said to be in fluid refractory shock and requires inotropic support. Mortality and morbidity rates have been shown to be reduced with rapid fluid resuscitation and early use of inotropic support. 2009 ACCM guidelines recommend starting peripheral inotropes where a delay in gaining central access is foreseeable. Literature demonstrates that guidelines are inconsistently followed, affecting the outcomes of children with sepsis.
Aims To explore how healthcare professionals are using current guidelines within their practice and evaluate the barriers and enablers to the initiation of inotropic support peripherally.
Methods A questionnaire was distributed to trainees within England and Wales to assess their understanding and application of sepsis guidelines. The questionnaire explored understanding of definitions of fluid refractory shock and assessed exposure to such cases, gauging the experience of trainees and the treatment barriers/ enablers they had encountered.
Results 84 responses were received from various training grades ST3 to ST8. 90% of respondents reported being familiar with local guidelines, with 45% correctly defining fluid refractory shock. 88% would initiate inotropes following 40 to 60mls/kg of fluid resuscitation and first line choice of inotrope was variable. 56% of trainees had never encountered a case of fluid refractory shock and 19% did not feel confident starting inotropes. Respondents who had previous PICU experience were more confident starting inotropes. Support from regional paediatric intensivists and local consultants were cited by many as an enabler to starting inotropes. Barriers included lack of knowledge, confidence levels and personal experience. Trainees commented that guidelines need to be more concise and training and education improved.
Conclusion Inconsistencies exist in the understanding and application of current guidelines. Trainees lack hands-on experience and training must reflect this through simulation and clear, concise algorithms. Local and regional support networks are essential in enabling rapid resuscitation. Trainees utilise modern technology in their practice and up-to-date online resources must reflect this.
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