Give intravenous fluid volume bolus of 10–20 ml/kg of colloid or normal saline |
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Continuously monitor |
• arterial blood pressure |
• central venous pressure (CVP) |
• heart rate |
• cutaneous oxygen saturation (SpO2) |
• urine output |
Maintain CVP at 8–12 mm Hg with fluid volume |
Up to 40–60 ml/kg might be required in the first six hours |
Optimise SpO2 with oxygen and mechanical ventilation |
Transfuse with packed cells if haemoglobin < 100 g/l |
Give clotting products as volume if there is a coagulopathy, but beware of hypotension caused by fresh frozen plasma |
Repeat lactate; if still high or blood pressure low, add dopamine at 5 μg/kg/min |
Apply mechanical ventilation to reduce respiratory muscle oxygen consumption and allow redistribution of cardiac output to vital organs |
Increase inotropic support if lactate still rising |
Consider that catecholamines, especially adrenaline (epinephrine), might also cause high lactate concentrations |
If the child is receiving adrenaline, and has an acceptable blood pressure but a rising lactate, reducing the adrenaline infusion rate might lower lactate |
Titrate the inotrope to the lowest infusion rate that will maintain |
• a blood pressure in the normal range for age |
• a urine output > 1 ml/kg/hour |
• a reduction in lactate |
If lactate continues to rise despite these measures, consider the use of extracorporeal life support |
↵1-150 Assumes appropriate antibiotics have been given.