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A network system for the treatment of pediatric septic shock


We show the effect of a network system in the treatment of pediatric septic shock, especially for children with Waterhouse–Friderichsen syndrome. In 2003 we founded a pediatric intensive care network with 15 children's hospitals in Lower Saxony, Germany. The aims were the standardisation of clinical therapies, implementation of training programs and the installation of an emergency system in the region of lower Saxony.


The first standard was implemented for the treatment of the Waterhouse–Friderichsen syndrome. At first, we started with the educational program. The program included different central symposia about septic shock in children. The second step was the standardisation of the diagnosis and the therapy, including the administration of human protein C concentrate (PC), and the clinical pathways. We implemented a round-the-clock emergency system with the possibility for transportation of critically ill patients, permanent consultation of the tertiary medical center and onsite treatment through the tertiary center staff if the patient could not be transferred. All patients were announced to the tertiary medical center directly after admission into the network hospitals. The final step was the presentation of the project in the different hospitals.


We treated 10 children with Waterhouse–Friderichsen syndrome in the network. Three of them were attended on site and seven were transferred in the tertiary center. The announcement time in eight cases was 15 minutes–1 hour. Primarily, a consultation was accomplishing routinely. The transportation team of the tertiary center continued the treatment on site and afterwards in the center. All patients showed typical signs of Waterhouse–Friderichsen syndrome with purpura fulminans and severe multiorgan failure. No patient died and only one patient had necrosis of the skin, which existed already at admission. The others had a restitution ad integrum. No adverse effects were observed with the PC concentrate administration.


The network system and the standard treatment with PC worked without severe problems. The survival rate and the outcome in our small study group were excellent. Our experience allows us to enlarge the system on other diseases.

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Sasse, M., Kirschstein, M., Köditz, H. et al. A network system for the treatment of pediatric septic shock. Crit Care 11 (Suppl 2), P42 (2007).

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