Children's Hospitals Today - Summer 2017 - 25

SEPSIS / FEATURE

S

ix-year-old Victoria was doing
cartwheels with neighborhood
friends on a Saturday night.
When she woke up the next morning with what looked like a virus, her
mom, Judith, wasn't too concerned.
But by Monday, Victoria's fever remained high. She was having trouble
breathing, which alerted an urgent
care physician to call 911. Little did her
family know, she was already in the
fight of her life.
Sepsis, a life-threatening complication
from an infection, comes disguised as
many things. For families, the experience
often starts in the doctor's office, urgent
care or emergency room with a simple
statement, "Something isn't right." For
clinicians, subtle symptoms of common
illnesses-a cold, a cough, a fever-
could signal sepsis. Families, many who
have never heard
the word sepsis, are
Read more stories
of children
on the front lines
with sepsis at
with clinicians as it
childrenshospitals
.org/sepsis.
runs its frightening
course in their child.
And because they know their child
best, families are influencing clinical
practice at children's hospitals across the
country. Open communication between
clinicians and families is important,
and in the Improving Pediatric Sepsis
Outcomes collaborative, clinicians are
turning to parents as partners in early
recognition and treatment. Factoring
in their perspectives early and often
has the potential to improve outcomes.
"Even
something
as
seemingly
insignificant like, 'He doesn't usually
look that way,' can trigger us to look
deeper," says Christiane Corriveau,
M.D., pediatric intensive care physician
at Children's National Health System
in Washington, D.C. "We need to have
our ears open to hear these things and
integrate them into the formula of what
could be going on."
Here's what it's like for the clinicians

working in the collaborative, as parents
reflect on the intense experience of
watching their child beat sepsis.

They said it was pneumonia
At the urgent care facility, Victoria had
tested positive for influenza A and strep
A. Then, after arriving at the hospital's
emergency department (ED), Victoria
was diagnosed with pneumonia; her
heart rate was high and oxygen levels
were low. Doctors put Victoria into
an induced coma and administered
antibiotics. But the antibiotics weren't
effective, and her organs began to fail.
She was going into septic shock-the
strep had moved into her blood. Victoria
experienced three cardiac arrests,
two in the ED and one in the intensive
care unit (ICU), before the care team
stabilized her. Her heart rate and fever
remained high.
Within 48 hours, Victoria was
transferred to Holtz Children's Hospital
at the University of Miami/Jackson
Memorial Medical Center, a hospital
that offered extracorporeal membrane
oxygenation, or ECMO, a therapy that
would save Victoria's life. "The doctors
there were very educated about sepsis
and took time to explain what was
happening to my daughter," Judith
says. "The PICU nurses were vigilant
and alerted me whenever something
changed. Their preparedness and
knowledge saved my daughter's life."
After more than 17 days on the ECMO
machine, 10 days longer than the
average treatment, Victoria began to
recover. She underwent three months
of rehabilitation in the hospital and
continued physical therapy long after.
Judith says she learned a valuable
lesson as a parent. "Listen to what
your child is telling you. Victoria was
complaining her legs and belly were
hurting. I thought, 'Oh, it's probably the
Tylenol.' By Monday, I knew something
was wrong."

Victoria's story is a familiar scenario
for children's hospital physicians, who
see children when sepsis has progressed
to a dangerous level. Providers in
critical care depend on colleagues in
other areas, like the ED, to recognize
sepsis early, which can be difficult to do.
"That illustrates the critical importance
of having a consistent, systematic
approach to recognizing sepsis,"
Corriveau says. "Clinicians in every area
need to look at it with the same eyes and
same suspicion. We should all be on the
same page so we don't have a delay in
recognition or transfer to the ICU. When
it's really obvious, often it's too late."

We had to keep looking
At Mayo Clinic Children's Center in
Rochester, Minnesota, Charles Huskins,
M.D., vice chair of Quality, remembers
another young girl admitted to the ED
who had difficulty communicating her
symptoms and pain. After a careful
evaluation, lab tests and a blood culture
came back negative. Additional imaging
studies showed no abnormalities.
Several hours later, the patient's mother
noticed a change in her daughter's
mental status, which triggered the
nurse to reassess vital signs and call
in the team. She was deteriorating to
severe sepsis.
"Everything looked fine in the
ED other than the child appeared
distressed, but every test we did was
normal," Huskins says. "We couldn't find
the answer." But hours later, another
blood culture came back positive. The
infection progressed rapidly. "That's
the dynamic nature of sepsis-it can
turn quickly and appear differently
in each child. We have to be vigilant
and we have to assess and reassess,"
he says. "The input from the parents is
critical-that's another flag something
is wrong." The patient survived sepsis
because monitoring processes-and a
strong partnership between parent and

CHILDREN'S HOSPITAL S TODAY Summer 2017

25
http://childrenshospitals.org/sepsis
Table of Contents for the Digital Edition of Children's Hospitals Today - Summer 2017
