Nepal Paediatric Society Clinical Guidance for Management of Sepsis and Septic Shock in the Paediatric Intensive Care Units in Nepal

  • Sangita Basnet Department of Paediatrics, Southern Illinois University, School of Medicine, Springfield, Illinois, USA and Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Nepal https://orcid.org/0000-0002-0657-8386
  • Dhruba Shrestha Department of of Paediatrics, Siddhi Memorial Women and Children's Hospital, Bhaktapur, Nepal
  • Puja Amatya Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Nepal
  • Arun Sharma Department of Paediatrics, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
  • Binod Lal Bajracharya Department of Paediatrics, Past President of NEPAS
  • Anil Shrestha Department of Paediatrics, Kanti Children’s Hospital, Kathmandu, Nepal
  • Sudeep Shrestha Specialty Trainee, Tunbridge Wells Hospital, UK
  • Pramila Rajchal Department of Paediatrics, Scheer Adventist Memorial Hospital, Banepa, Nepal
  • Raju Kafle Department of Paediatrics, Universal College of Medical Sciences, Bhairahwa, Nepal
  • Devendra Shrestha Department of Paediatrics, KIST Hospital, Kathmandu, Nepal
  • Sangeeta Puri Department of Paediatrics, Nepal Medical College, Kathmandu, Nepal
  • Anwesh Bhatta Department of Paediatrics, Kathmandu Medical College, Kathmandu, Nepal
  • Om Krishna Pathak Department of Paediatrics, Bharatpur Hospital, Chitwan, Nepal
  • Shrijana Shrestha Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Nepal
Keywords: Sepsis, septic shock, pediatrics, Nepal, Guidelines, management, Critical care

Abstract

Justification: Sepsis is a major cause of morbidity and mortality in Nepal. There is a lack of standardisation in the management of severe sepsis and septic shock. Additionally, international guidelines may not be completely applicable to resource limited countries like Nepal.

Objective: Create a collaborative standardised protocol for management of severe sepsis and septic shock for Nepal based on evidence and local resources.

Process / Methods: Paediatricians representing various paediatric intensive care units all over Nepal gathered to discuss clinical practice and delivery of care of sepsis and septic shock under the aegis of Nepal Paediatric Society. After three meetings and several iterations a standardised protocol and algorithm was developed by modifying the existing Surviving Sepsis Guidelines to suit local experience and resources.

Recommendations: Paediatric sepsis and septic shock definitions and management in the early hours of presentation are outlined in text and flow diagram format to simplify and standardise delivery of care to children in the paediatric intensive care setting. These are guidelines and may need to be modified as necessary depending on the resources availability and lack thereof. It is recommended to analyse data moving forward and revise every few years in the advent of additional data.

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Author Biography

Sangita Basnet, Department of Paediatrics, Southern Illinois University, School of Medicine, Springfield, Illinois, USA and Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Nepal

Dr. Sangita Basnet is a Professor of Pediatrics and Pediatric Critical Care at Southern Illinois University School of Medicine. Currently she is an Adjunct Professor at Patan Academy of Health Sciences in Kathmandu Nepal. Until recently she was the chief of pediatric critical care and medical director of the Pediatric Intensive Care Unit at St. John’s Children’s Hospital in Springfield, Illinois. She completed a three-year fellowship in critical care at Washington University School of Medicine in St. Louis and a three-year pediatric residency at Cook County Children's Hospital in Chicago. She earned her medical degree at Tribhuvan University, Institute of Medicine in Kathmandu, Nepal. Dr Basnet is board certified in pediatric critical care medicine and pediatrics by the American Board of Pediatrics, and is a Fellow of the American College of Critical Care Medicine and the American Academy of Pediatrics. Her overarching goal is to improve child health outcomes internationally. She returned to her native country Nepal after 27 years in the United States with the dream to improve and enhance pediatric critical care delivery to the children of Nepal and establish a Pediatric Critical Care Fellowship. She played a key role in establishing pediatric and neonatal intensive care units in Nepal in the year 2009, and has been training and working in the units over the years. She also recently initiated a Pediatric Critical Care Working group in Nepal to facilitate development of standardized protocols to decrease variability in management of critically ill children. Dr Basnet has published and presented widely on pediatric critical care in resource limited countries and quality improvement interventions in the pediatric ICU.

Published
2021-04-24
How to Cite
Basnet, S., Shrestha, D., Amatya, P., Sharma, A., Bajracharya, B., Shrestha, A., Shrestha, S., Rajchal, P., Kafle, R., Shrestha, D., Puri, S., Bhatta, A., Pathak, O., & Shrestha, S. (2021). Nepal Paediatric Society Clinical Guidance for Management of Sepsis and Septic Shock in the Paediatric Intensive Care Units in Nepal. Journal of Nepal Paediatric Society, 41(1), 1-10. https://doi.org/10.3126/jnps.v41i1.35075
Section
Review Article