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Septic Shock

Date Last Search Run: Mar 05, 2026
Table last updated: Nov 26, 2025
Data last added: Nov 16, 2025

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)    
2 (fair evidence exists)    
3 (weak evidence exists)  


Interventions

Aggressive Crystalloids
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Functional gelatin in saline) in pediatric septic shock. Indian Pediatr Patient ED-MD Upadhyay M., Singhi S., Murlidharan J., Kaur N., Majumdar S. Randomized evaluation of fluid resuscitation with crystalloid (saline) and colloid (polymer from degraded gelatin in saline) in pediatric septic shock. Indian Pediatr 2005; 42(3):223-231. Medline
II Supportive (Green) LOS Patient ED-MD Paul R., Neuman MI., Monuteaux MC., Melendez E. Adherence to PALS sepsis guidelines and hospital length of stay. Pediatrics 2012; 130(2):e273-80. Medline
II Neutral (Yellow) Efficacy Patient ED-MD Akech S., Ledermann H., Maitland K. Choice of fluids for resuscitation in children with severe infection and shock: systematic review. BMJ 2010; 2:341. Medline
III Neutral (Yellow) Hospital mortality Patient ED-MD Santhanam I., Sangareddi S., Venkataraman S., Kissoon N., Thiruvengadamudayan V., Kasthuri RK. A prospective randomized controlled study of two fluid regimens in the initial management of septic shock in the emergency department. Pediatr Emerg Care 2008; 24(10):647-55. Medline

Colloid Infusion
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Functional gelatin in saline) in pediatric septic shock. Indian Pediatr Patient ED-MD Upadhyay M., Singhi S., Murlidharan J., Kaur N., Majumdar S. Randomized evaluation of fluid resuscitation with crystalloid (saline) and colloid (polymer from degraded gelatin in saline) in pediatric septic shock. Indian Pediatr 2005; 42(3):223-231. Medline
II Neutral (Yellow) Apnea Patient ED-MD Akech S., Ledermann H., Maitland K. Choice of fluids for resuscitation in children with severe infection and shock: systematic review. BMJ 2010; 2:341. Medline
III Neutral (Yellow) Hospital mortality Patient ED-MD Santhanam I., Sangareddi S., Venkataraman S., Kissoon N., Thiruvengadamudayan V., Kasthuri RK. A prospective randomized controlled study of two fluid regimens in the initial management of septic shock in the emergency department. Pediatr Emerg Care 2008; 24(10):647-55. Medline

Early Goal Directed Therapy
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Guideline adherence Process ED-MD Larsen GY., Mecham N., Greenberg R. An emergency department septic shock protocol and care guideline for children initiated at triage. Pediatrics 2011; 127(6):e1585-92. Medline
II Supportive (Green) LOS Patient ED-MD Paul R., Neuman MI., Monuteaux MC., Melendez E. Adherence to PALS sepsis guidelines and hospital length of stay. Pediatrics 2012; 130(2):e273-80. Medline

Identification tools
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Predictive value Process ED-MD Georgette N, Michelson K, Monuteaux M, Eisenberg MA. Comparing Screening Tools for Predicting Phoenix Criteria Sepsis and Septic Shock Among Children. Pediatrics May 2025;155(5). Medline
III Supportive (Green) Sens/spec for prediction of severe sepsis Process Balamuth F., Alpern ER., Abbadessa MK., Hayes K., Schast A., Lavelle J., et al. Improving Recognition of Pediatric Severe Sepsis in the Emergency Department: Contributions of a Vital Sign-Based Electronic Alert and Bedside Clinician Identification. Ann Emerg Med 2017; 70(6):759-68.e2. Medline

Manual Intraosseous Insertion
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Success Patient ED-MD Voigt J., Waltzman M., Lottenberg L. Intraosseous vascular access for in-hospital emergency use: A systematic clinical review of the literature and analysis. Pediatr Emerg Care 2012; 28(2):185-199. Medline

Mechanical Intraosseous Insertion
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Success Patient ED-MD Voigt J., Waltzman M., Lottenberg L. Intraosseous vascular access for in-hospital emergency use: A systematic clinical review of the literature and analysis. Pediatr Emerg Care 2012; 28(2):185-199. Medline

Point of Care Lactate
Level Direction Primary Outcome Patient/Process Setting Reference

Pressors
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Resolution of shock Patient ED-MD Ramaswamy KN., Singhi S., Jayashree M., Bansal A., Nallasamy K. Double-Blind Randomized Clinical Trial Comparing Dopamine and Epinephrine in Pediatric Fluid-Refractory Hypotensive Septic Shock. Pediatr Crit Care Med 2016; 17(11):e502-12. Medline
II Neutral (Yellow) Mortality Patient ED-MD Jeffreys KL, Eckerle M, Depinet H. Patterns of Vasoactive Agent Initiation Among Children With Septic Shock in the Pediatric Emergency Department. Pediatr Emerg Care 2022; 38(1):e205–8. Medline
X Not Yet Graded (White) - Cannavò L, Capitanio L, Beretta V, Raitano V, Perrone S. Early inotropic support in pediatric shock: evidence and challenges in prehospital setting and interfacility transport. Am J Emerg Med. January 2026; 102:180-189. Medline

Restricted Crystalloids
Level Direction Primary Outcome Patient/Process Setting Reference
III Neutral (Yellow) Hospital mortality Patient ED-MD Santhanam I., Sangareddi S., Venkataraman S., Kissoon N., Thiruvengadamudayan V., Kasthuri RK. A prospective randomized controlled study of two fluid regimens in the initial management of septic shock in the emergency department. Pediatr Emerg Care 2008; 24(10):647-55. Medline

Temperature Monitoring
Level Direction Primary Outcome Patient/Process Setting Reference


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