Children's Hospitals Today - Summer 2017 - 27

SEPSIS / FEATURE

or something different?
In these situations, parents can
be a valuable resource for clinicians.
Parents can provide an important
perspective by communicating what's
normal for their child, which helps
clinicians determine the probability
of sepsis. This was the case of Chloe,
a 12-year-old, non-verbal patient with
autism and a seizure disorder.

She looked like she
had been sedated
When Chloe went from being tired
after school to weak and unresponsive
with a high fever, the Miller family
knew something was wrong. "Even
after we got her
fever down, Chloe
Learn why
sepsis is more
just wasn't herself,"
than just a cut at
says her father,
childrenshospitals
.org/morethanacut.
Mark. As parents
of a child with
complex medical conditions, he and
wife Amy were very aware of changes
in their daughter's health.
At Children's National Medical Center,
Chloe had low blood pressure and pale
coloring. The typically resilient preteen was having trouble breathing and
was rushed to the ICU. "Chloe looked
like she had been sedated even though
she hadn't been," Mark says. "She didn't
respond to things that normally would
have been frightening and painful. That
was scary."
Chloe developed sepsis as a result
of having influenza A, pneumonia
and strep throat at the same time.
Although this can happen to anybody,

Evaluate patients with severe
sepsis; determine extent and
severity of organ dysfunction.

3. DIAGNOSTIC EVALUATION
Tell us if physical findings
suggest severe sepsis or septic
shock; explain labs and tests.

it's more dangerous for individuals with
underlying medical conditions. That
first night in the hospital was a flurry
of activity, with doctors and nurses
providing regular updates to the family.
Mark and Amy told the care team Chloe
previously had a bad experience with
intubation, which typically is part of the
supportive care process when treating
sepsis. The team was alarmed by Chloe's
labored breathing, but they agreed
to wait until absolutely necessary to
intubate her. Fortunately, she was able
to successfully breathe on her own the
entire time she was in the hospital.
Corriveau saw Chloe in the PICU
several hours after she arrived in the
ED. "Her parents told us things we
wouldn't have known otherwise, which
ultimately affected her care," she says.
"Kids come attached with families, so we
need to help them be on the team."
Four days later, Chloe started to
recover. The Millers worked closely
with the medical team to explain her
reactions and how she was feeling, and
they participated in regular meetings
with the care team. However, Mark
recalls the team didn't mention sepsis
until later. "The word sepsis is scary,
especially when you Google it," he
says. "But having a diagnosis when we
got to the ICU might have helped us
understand the bigger picture of what
was happening."
After an experience with sepsis,
families wonder why physicians
don't always mention sepsis in early
conversations with them. Huskins
acknowledges it is a term clinicians

Ensure patients with severe
sepsis receive appropriate,
timely and effective treatment.

4. RESUSCITATION/STABILIZATION
Tell us how to recognize
severe sepsis; review clinical
information with us.

could use more often, but the emphasis
is on treating the underlying problem.
"We tend to focus on the other aspects
of care-high blood pressure or the
infection that's leading to sepsis-and
be as concrete as possible with families,"
Huskins says. "If another physician told
me, 'We have a patient with sepsis,' I
would ask, "'From what? What's driving
the sepsis?' You need to get to the source
and control it. That's an important
element of the sepsis collaborative."

Everyone has a role
Sepsis is not a simple condition to
understand. There's no one test that
points to it. One thing every clinician
can agree on is that a proactive
multidisciplinary approach, coupled
with family involvement, is critical to
early recognition of sepsis and better
outcomes. That's the foundation of the
sepsis collaborative.
"One of our biggest challenges with
sepsis is putting a name on it," Corriveau
says. "And despite the science and
antibiotics and great team dynamics in
our day-to-day care, we still miss kids.
But the sepsis collaborative challenges
us to ask more questions, recognize
the possibility of sepsis, break down
silos across specialties and listen to the
families. The interventions ensure we
have the same focus and same reaction
in all areas of the hospital and that these
can be individualized to the needs of the
child. These are the breakthroughs we
can accomplish."
Send questions or comments to
magazine@childrenshospitals.org.

De-escalate care for patients
with severe sepsis and initiate
rehabilitative care.

5. DE-ESCALATION
Summarize the main issues;
outline ongoing and future
goals for our child.

CHILDREN'S HOSPITAL S TODAY Summer 2017

27
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