Jaime Fernández-Sarmiento1, Daniela Carla De Souza2, Anacaona Martinez3, Victor Nieto4, Jesús López-Herce5, Vanessa Soares Lanziotti6, María Del Pilar Arias López7, Werther Brunow De Carvalho8, Claudio F Oliveira9, Juan Camilo Jaramillo-Bustamante10, Franco Díaz11, Adriana Yock-Corrales12, Silvina Ruvinsky13, Manuel Munaico14, Viviana Pavlicich15, Ricardo Iramain16, Marta Patricia Márquez17, Gustavo González18, Mauricio Yunge19, Cristian Tonial20, Pablo Cruces21, Gladys Palacio22, Carolina Grela23, Maria Slöcker-Barrio24, Santiago Campos-Miño25, Sebastian González-Dambrauskas26, Nelson L Sánchez-Pinto27,28, Pedro Celiny García29, Roberto Jabornisky30. 1. Fundación Cardioinfantil - Instituto de Cardiología, Universidad de la Sabana, CES Graduate School, Bogotá, Colombia. 2. Hospital Universitario da Universidad de São Paulo and Hospital Sírio Libanês, Sao Paulo, Brazil. 3. Universidad CES, Bogotá, Colombia. 4. Department of Critical Care Medicine, Cobos Medical Center, Chief Research Group GriBos, Bogotá, Colombia. 5. Department of Pediatric Intensive Care, Hospital General Universitario Gregorio Marañón; Department of Public and Maternal-Infant Health, Universidad Complutense de Madrid, Red de Salud Maternoinfantil y del Desarrollo, Madrid, España. 6. Pediatric Intensive Care Unit & Research and Education Division/Maternal and Child Health Postgraduate Program, Institute of Pediatrics, Federal University of Rio De Janeiro, Rio De Janeiro, Brazil. 7. Pediatric Intensive Care Unit, Hospital de Niños Ricardo Gutierrez, Programa SATI-Q, Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina. 8. Neonatology and Intensive Care Pediatrics, Department of Medical University of São Paulo, São Paulo, Brazil. 9. The Latin America Sepsis Institute, São Paulo, Brazil. 10. Department of Pediatrics and Intensive Care, Hospital General de Medellín, Universidad de Antioquia, Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Medellín, Colombia. 11. Instituto de Ciencias e Innovacion en Medicina, Universidad del Desarrollo y Hospital El Carmen de Maipu, Santiago, Chile. 12. Emergency Department, Hospital Nacional de Niños "Dr. Carlos Saenz Herrera", CCSS, Pediatric Emergency Physician, San José, Costa Rica. 13. Department of Infectious Diseases, Hospital de Pediatría Juan P. Garrahan, Latin American Society of Infectious Disease, Buenos Aires, Argentina. 14. Pediatric Intensive Care Unit, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú. 15. Hospital General Pediátrico Niños de Acosta Ñu, Universidad Privada del Pacífico, Asunción, Paraguay. 16. Pediatric Emergency Department, Hospital de Clínicas, Universidad Nacional de Asunción, Asunción, Paraguay. 17. Department of Pediatric Intensive Care, Instituto Nacional de Pediatría, Ciudad de México, México. 18. Pediatric Intensive Care Unit, Complejo Médico "CHURUCA VISCA", Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina. 19. Department of Pediatric Intensive Care, Clínica Los Condes, Santiago, Chile. 20. Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Porto Alegre, RS, Brazil. 21. Department of Pediatric Intensive Care, Hospital El Carmen de Maipú, Centro de Investigación de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Chile. 22. Department of Pediatric Intensive Care Unit Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina. 23. Universidad de la República, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay. 24. Hospital General Universitario Gregorio Marañón, Madrid, España. 25. Department of Pediatric Intensive Care Unit, Hospital Metropolitano, Latin American Center for Clinical Research, Quito - Ecuador. 26. Red Colaborativa Pediátrica de Latinoamérica (LARed Network) - Montevideo, Uruguay. Specialized Pediatric Intensive Care, Casa de Galicia, Montevideo, Uruguay. 27. Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 28. Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA. 29. Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Serviço de Medicina Intensiva e Emergência, Porto Alegre, RS, Brazil. 30. Department of Pediatrics, Facultad de Medicina, Universidad Nacional del Nordeste, Argentina.
Abstract
Objective: The aim of this study was to develop evidence-based recommendations for the diagnosis and treatment of sepsis in children in low- and middle-income countries (LMICs), more specifically in Latin America. Design: A panel was formed consisting of 27 experts with experience in the treatment of pediatric sepsis and two methodologists working in Latin American countries. The experts were organized into 10 nominal groups, each coordinated by a member. Methods: A formal consensus was formed based on the modified Delphi method, combining the opinions of nominal groups of experts with the interpretation of available scientific evidence, in a systematic process of consolidating a body of recommendations. The systematic search was performed by a specialized librarian and included specific algorithms for the Cochrane Specialized Register, PubMed, Lilacs, and Scopus, as well as for OpenGrey databases for grey literature. The GRADEpro GDT guide was used to classify each of the selected articles. Special emphasis was placed on search engines that included original research conducted in LMICs. Studies in English, Spanish, and Portuguese were covered. Through virtual meetings held between February 2020 and February 2021, the entire group of experts reviewed the recommendations and suggestions. Result: At the end of the 12 months of work, the consensus provided 62 recommendations for the diagnosis and treatment of pediatric sepsis in LMICs. Overall, 60 were strong recommendations, although 56 of these had a low level of evidence. Conclusions: These are the first consensus recommendations for the diagnosis and management of pediatric sepsis focused on LMICs, more specifically in Latin American countries. The consensus shows that, in these regions, where the burden of pediatric sepsis is greater than in high-income countries, there is little high-level evidence. Despite the limitations, this consensus is an important step forward for the diagnosis and treatment of pediatric sepsis in Latin America.
Objective: The aim of this study was to develop evidence-based recommendations for the diagnosis and treatment of sepsis in children in low- and middle-income countries (LMICs), more specifically in Latin America. Design: A panel was formed consisting of 27 experts with experience in the treatment of pediatric sepsis and two methodologists working in Latin American countries. The experts were organized into 10 nominal groups, each coordinated by a member. Methods: A formal consensus was formed based on the modified Delphi method, combining the opinions of nominal groups of experts with the interpretation of available scientific evidence, in a systematic process of consolidating a body of recommendations. The systematic search was performed by a specialized librarian and included specific algorithms for the Cochrane Specialized Register, PubMed, Lilacs, and Scopus, as well as for OpenGrey databases for grey literature. The GRADEpro GDT guide was used to classify each of the selected articles. Special emphasis was placed on search engines that included original research conducted in LMICs. Studies in English, Spanish, and Portuguese were covered. Through virtual meetings held between February 2020 and February 2021, the entire group of experts reviewed the recommendations and suggestions. Result: At the end of the 12 months of work, the consensus provided 62 recommendations for the diagnosis and treatment of pediatric sepsis in LMICs. Overall, 60 were strong recommendations, although 56 of these had a low level of evidence. Conclusions: These are the first consensus recommendations for the diagnosis and management of pediatric sepsis focused on LMICs, more specifically in Latin American countries. The consensus shows that, in these regions, where the burden of pediatric sepsis is greater than in high-income countries, there is little high-level evidence. Despite the limitations, this consensus is an important step forward for the diagnosis and treatment of pediatric sepsis in Latin America.