{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:14:36Z","timestamp":1753892076348,"version":"3.41.2"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T00:00:00Z","timestamp":1641945600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p><jats:bold>Introduction:<\/jats:bold> Pediatric septic shock and acute respiratory distress syndrome (pARDS) are major causes of morbidity and mortality in pediatric intensive care units (PICUs). While standardized guidelines for sepsis and pARDS are published regularly, their implementation and adherence to guidelines are different in resource-rich and resource-limited countries. The purpose of this study was to conduct a survey to ascertain variation in current clinician-reported practice in pediatric septic shock and acute respiratory distress syndrome, and the clinician skills in a variety of hospital settings throughout Thailand.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> We conducted an electronic survey in pediatricians throughout the country between August 2020 and February 2021 using multiple choice questions and clinical case scenarios based on the 2017 American College of Critical Care Medicine's Consensus guideline for pediatric and neonatal septic shock and the 2015 Pediatric Acute Lung Injury Consensus Conference.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> The survey elicited responses from 255 pediatricians (125 general pediatricians, 38 pulmonologists, 27 cardiologists, 32 intensivists, and 33 other subspecialists), with 54.5% of the respondents having &amp;lt;5 years of PICU experience. Among the six sepsis scenarios, 72.5 and 78.4% of the respondents had good adherence to the guidelines for managing fluid refractory shock and sedation for intubation, respectively. The ICU physicians reported greater adherence during more complex shock. In ARDS scenarios, 80.8% of the respondents reported having difficulty diagnosing ARDS mimic conditions and used lesser PEEP than the recommendation. Acceptance of permissive hypercapnia and mild hypoxemia was accepted by 62.4 and 49.4% of respondents, respectively. The ICU physicians preferred decremental PEEP titration, whereas general pediatricians preferred incremental PEEP titration.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> This survey variation could be the result of resource constraints, knowledge gaps, or ambiguous guidelines. Understanding the perspective and rationale for variation in pediatricians' practices is critical for successful guideline implementation.<\/jats:p>","DOI":"10.3389\/fped.2021.792524","type":"journal-article","created":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T07:04:08Z","timestamp":1641971048000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of Pediatric Septic Shock and Acute Respiratory Distress Syndrome in Thailand: A Survey of Pediatricians"],"prefix":"10.3389","volume":"9","author":[{"given":"Pasita","family":"Puttiteerachot","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nattachai","family":"Anantasit","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chanapai","family":"Chaiyakulsil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jarin","family":"Vaewpanich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rojjanee","family":"Lertburian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marut","family":"Chantra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,1,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1097\/PCC.0000000000001502","article-title":"Hospital variation in risk-adjusted pediatric sepsis mortality","volume":"19","author":"Ames","year":"2018","journal-title":"Pediatr Crit Care Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1097\/PCC.0000000000000225","article-title":"Pediatric severe sepsis in U.S. children's hospitals","volume":"15","author":"Balamuth","year":"2014","journal-title":"Pediatr Crit Care Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1001\/jama.2018.9071","article-title":"Association between the new york sepsis care mandate and in-hospital mortality for pediatric sepsis","volume":"320","author":"Evans","year":"2018","journal-title":"JAMA."},{"key":"B4","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1542\/peds.2006-2353","article-title":"Patient and hospital correlates of clinical outcomes and resource utilization in severe pediatric sepsis","volume":"119","author":"Odetola","year":"2007","journal-title":"Pediatrics"},{"key":"B5","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1016\/j.jpeds.2018.03.056","article-title":"Children with chronic disease bear the highest burden of pediatric sepsis","volume":"199","author":"Prout","year":"2018","journal-title":"J Pediatr."},{"key":"B6","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/S2213-2600(18)30344-8","article-title":"Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study","volume":"7","author":"Khemani","year":"2019","journal-title":"Lancet Respir Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1097\/PCC.0000000000002680","article-title":"Pediatric severe sepsis and shock in three asian countries: a retrospective study of outcomes in nine PICUs","volume":"22","author":"Samransamruajkit","year":"2021","journal-title":"Pediatr Crit Care Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1820","DOI":"10.1097\/CCM.0000000000002623","article-title":"Risk stratification in pediatric acute respiratory distress syndrome: a multicenter observational study","volume":"45","author":"Wong","year":"2017","journal-title":"Crit Care Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1097\/CCM.0000000000002425","article-title":"American college of critical care medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock","volume":"45","author":"Davis","year":"2017","journal-title":"Crit Care Med."},{"key":"B10","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1097\/PCC.0000000000000350","article-title":"Pediatric acute respiratory distress syndrome: consensus recommendations from the pediatric acute lung injury consensus conference","volume":"16","year":"2015","journal-title":"Pediatr Crit Care Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1542\/peds.112.4.793","article-title":"Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome","volume":"112","author":"Han","year":"2003","journal-title":"Pediatrics."},{"key":"B12","doi-asserted-by":"publisher","first-page":"S271","DOI":"10.1513\/AnnalsATS.201704-337OT","article-title":"Low tidal volume versus non-volume-limited strategies for patients with acute respiratory distress syndrome. A systematic review and meta-analysis","volume":"14","author":"Walkey","year":"2017","journal-title":"Ann Am Thorac Soc"},{"key":"B13","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1097\/PCC.0b013e3181d904c0","article-title":"Acute lung injury in children: therapeutic practice and feasibility of international clinical trials","volume":"11","author":"Santschi","year":"2010","journal-title":"Pediatr Crit Care Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/s13613-019-0545-4","article-title":"Translational gap in pediatric septic shock management: an ESPNIC perspective","volume":"9","author":"Morin","year":"2019","journal-title":"Ann Intensive Care."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e534","DOI":"10.1111\/apa.12413","article-title":"Ketamine and atropine decrease pain for preterm newborn tracheal intubation in the delivery room: an observational pilot study","volume":"102","author":"Barois","year":"2013","journal-title":"Acta Paediatr."},{"key":"B16","doi-asserted-by":"publisher","first-page":"e289","DOI":"10.1097\/PCC.0b013e31828a8624","article-title":"The effect of atropine on rhythm and conduction disturbances during 322 critical care intubations","volume":"14","author":"Jones","year":"2013","journal-title":"Pediatr Crit Care Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1097\/INF.0000000000001380","article-title":"Evaluation of early corticosteroid therapy in management of pediatric septic shock in pediatric intensive care patients: a randomized clinical study","volume":"36","author":"El-Nawawy","year":"2017","journal-title":"Pediatr Infect Dis J."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1411","DOI":"10.1097\/CCM.0000000000003262","article-title":"Corticosteroids in sepsis: an updated systematic review and meta-analysis","volume":"46","author":"Rochwerg","year":"2018","journal-title":"Crit Care Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1007\/s00134-018-5197-6","article-title":"Low-dose corticosteroids for adult patients with septic shock: a systematic review with meta-analysis and trial sequential analysis","volume":"44","author":"Ryg\u00e5rd","year":"2018","journal-title":"Intensive Care Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1097\/PCC.0b013e31828a7287","article-title":"A survey of stated physician practices and beliefs on the use of steroids in pediatric fluid and\/or vasoactive infusion-dependent shock","volume":"14","author":"Menon","year":"2013","journal-title":"Pediatr Crit Care Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"e332","DOI":"10.1097\/PCC.0b013e31828a89a2","article-title":"Mechanical ventilation strategies in children with acute lung injury: a survey on stated practice pattern*","volume":"14","author":"Santschi","year":"2013","journal-title":"Pediatr Crit Care Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1001\/jama.2016.0291","article-title":"Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries","volume":"315","author":"Bellani","year":"2016","journal-title":"JAMA."},{"key":"B23","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1164\/rccm.201707-1404OC","article-title":"positive end-expiratory pressure lower than the ARDS network protocol is associated with higher pediatric acute respiratory distress syndrome mortality","volume":"198","author":"Khemani","year":"2018","journal-title":"Am J Respir Crit Care Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1097\/PCC.0b013e3182976251","article-title":"Impact of positive end-expiratory pressure on cardiac index measured by ultrasound cardiac output monitor*","volume":"15","author":"Ingaramo","year":"2014","journal-title":"Pediatr Crit Care Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1465","DOI":"10.1164\/rccm.201004-0606CI","article-title":"The design of future pediatric mechanical ventilation trials for acute lung injury","volume":"182","author":"Khemani","year":"2010","journal-title":"Am J Respir Crit Care Med."},{"key":"B26","first-page":"17","article-title":"Lung recruitment: the role of recruitment maneuvers","volume":"47","author":"Hess","year":"2002","journal-title":"Respir Care."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1688","DOI":"10.4187\/respcare.04409","article-title":"Recruitment maneuvers and PEEP titration","volume":"60","author":"Hess","year":"2015","journal-title":"Respir Care."},{"key":"B28","doi-asserted-by":"publisher","first-page":"278","DOI":"10.5492\/wjccm.v4.i4.278","article-title":"Recruitment maneuvers in acute respiratory distress syndrome: the safe way is the best way","volume":"4","author":"Santos","year":"2015","journal-title":"World J Crit Care Med."},{"key":"B29","doi-asserted-by":"publisher","first-page":"5","DOI":"10.3389\/fped.2016.00005","article-title":"A review of pediatric critical care in resource-limited settings: a look at past, present, future directions","volume":"4","author":"Turner","year":"2016","journal-title":"Front Pediatr."}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.792524\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T07:04:10Z","timestamp":1641971050000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.792524\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,12]]},"references-count":29,"alternative-id":["10.3389\/fped.2021.792524"],"URL":"https:\/\/doi.org\/10.3389\/fped.2021.792524","relation":{},"ISSN":["2296-2360"],"issn-type":[{"type":"electronic","value":"2296-2360"}],"subject":[],"published":{"date-parts":[[2022,1,12]]},"article-number":"792524"}}