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Assessment of adherence to the 2020 Surviving Sepsis Campaign guidelines for fluid resuscitation in children with suspected septic shock in paediatric emergency departments: a prospective multicentre study
  1. Julian San Geroteo1,
  2. Michael Levy1,
  3. Marion Bailhache2,
  4. Claire De Jorna3,
  5. Elodie Privat3,
  6. Oussama Gasmi4,
  7. Maria Fuentes-Lopez5,
  8. Yacine Laoudi6,
  9. Mustapha Mazeghrane7,
  10. Aline Malterre8,
  11. Pauline Bories9,
  12. Khaled Abdel Aal10,
  13. Iozefina Arjoca11,
  14. Jean Gaschignard12,
  15. Davy Tanchaleune13,
  16. Philippe Minodier14,
  17. Fabien Audren15,
  18. Tifanny Mazetier16,
  19. Pauline Quagliaro17,
  20. Florence Raimond18,
  21. Soria Sieng19,
  22. Blandine Robert20,
  23. Delphine Wohrer21,
  24. Nathalie De Suremain22,
  25. Stéphane Dauger1
  1. 1Pediatric Intensive Care Unit, Robert-Debré Mother-Child University Hospital, Paris, France
  2. 2Pediatric Emergency Department, University Hospital Centre Bordeaux Pellegrin Hospital Group Children's Hospital, Bordeaux, France
  3. 3Pediatric Emergency Department, Lille University Hospital Center, Lille, France
  4. 4Pediatric Emergency Department, University Hospital Centre Nantes, Nantes, France
  5. 5Pediatric Emergency Department, University Hospital Necker for Sick Children, Paris, France
  6. 6Pediatric Emergency Department, Intermunicipal Hospital Centre Robert Ballanger, Aulnay sous Bois, France
  7. 7Pediatric Emergency Department, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France
  8. 8Pediatric Emergency Department, Centre Hospitalier Intercommunal de Créteil, Creteil, France
  9. 9Pediatric Emergency Department, Hospital Louis-Mourier, Colombes, France
  10. 10Pediatric Emergency Department, Hospital Centre Gonesse, Gonesse, France
  11. 11Pediatric Emergency Department, Centre Hospitalier François Quesnay, Mantes-la-Jolie, France
  12. 12Pediatric Emergency Department, Groupement Hospitalier Nord Essonne, Longjumeau, France
  13. 13Pediatric Emergency Department, Hospital Bicetre, Le Kremlin-Bicetre, France
  14. 14Pediatric Emergency Department, Public Assistance–Hospitals of Marseille, Marseille, France
  15. 15Pediatric Emergency Department, Intermunicipal Hospital Centre Villeneuve Saint Georges, Villeneuve Saint Georges, France
  16. 16Pediatric Emergency Department, Hospital Centre Victor Dupouy Argenteuil, Argenteuil, France
  17. 17Pediatric Emergency Department, Hospital Jean Verdier, Bondy, France
  18. 18Pediatric Emergency Department, Hospital Antoine-Beclere, Clamart, France
  19. 19Pediatric Emergency Department, Grand Hopital de l'Est Francilien, Jossigny, France
  20. 20Pediatric Emergency Department, Centre Hospitalier de Pontoise, Pontoise, France
  21. 21Pediatric Emergency Department, Robert-Debré Mother-Child University Hospital, Paris, France
  22. 22Pediatric Emergency Department, Armand-Trousseau Children's Hospital, Paris, France
  1. Correspondence to Dr Julian San Geroteo, Pediatric Intensive Care Unit, Robert-Debré Mother-Child University Hospital, Paris 75019, France; julian.san-geroteo{at}


Background Paediatric sepsis is the leading cause of death in children under 5 years. No studies have evaluated the application of the Surviving Sepsis Campaign 2020 (SSC-2020) guidelines in paediatric emergency departments (PEDs).

Objective To assess physician adherence to the SSC-2020 fluid resuscitation guidelines in children with suspected septic shock in PEDs.

Methods This was a prospective multicentre observational study conducted in 21 French hospitals over 5 sequential weeks, between November 2021 and March 2022. Children with suspected septic shock and who received antimicrobial therapy within 72 hours were included. Primary outcome was SSC-2020 fluid resuscitation guidelines adherence (low 0–24%; moderate 25–74%; high 75–100%) according to: bolus volume of 10–20 mL/kg each, exclusive administration of balanced crystalloids at 1 and 24 hours of management, and initiation of fluid resuscitation within 1 hour of septic shock recognition.

Results 63 children were included. 10 (16%) children had severe sepsis and 2 (3%) met the definition of septic shock. Compared with the SSC-2020 guidelines, 43 (68%) patients received boluses of 10–20 mL/kg; fluid resuscitation was initiated within 1 hour of septic shock recognition in 42 (76%) cases; balanced crystalloids were the only fluids administrated in 35 (56%) and 34 (55%) children at 1 and 24 hours of management, respectively. Main barriers reported by physicians were difficult intravenous access (43%), lack of team training (29%), workload constraints (28%), and absence or out-of-date protocols (24%).

Conclusions This study found high adherence for fluid resuscitation initiation but moderate adherence for bolus volume and fluid choice.

Trial registration number NCT05066464.

  • Sepsis
  • Paediatric Emergency Medicine
  • Paediatrics
  • Intensive Care Units, Paediatric
  • Emergency Care

Data availability statement

Data are available upon reasonable request.

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  • Presented at This work was presented at the 2023 French Intensive Care Society International Congress.

  • Contributors JSG and SD conceptualised and designed the study and drafted the initial manuscript. JSG designed the data collection instruments and carried out the initial analyses. ML reviewed all medical files of children admitted to PICU and revised the manuscript. All authors collected data, critically reviewed the manuscript and gave their approval of the final version. JSG is the guarantor and accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.