There are particular patients who need an urgent response, and we have defined these criteria, which we refer to as ‘Go Now’ criteria. These are not meant as thresholds for referral, for many such children we would wish to be called earlier, but rather they are triggers for urgent departure of our retrieval team.
The PIPER Paediatric ‘Go Now’ Criteria are:
1. Suspected
severe sepsis and one or more of:
- Venous blood Lactate >3 mmol/L
- Neutropenia (neutrophil count <1000 / mm3), unexpected
(i.e. not related to cancer chemotherapy)
- Coagulopathy (INR>1.6, APTT>60, Fib <1)
- Signs of shock* persisting despite a total of 40ml/kg fluid
2. Upper airway
obstruction
persistent despite >2 doses of adrenaline, or hypoxic (SpO2<90%)
3. Pneumonia with
hypoxaemia
(SpO2 <90%) despite locally available non-invasive respiratory
support
4. Large pleural
effusion
(e.g. near white-out of hemi-thorax)
5. Surgical
abdomen
with signs of shock*
6. Ongoing seizures
despite 2 doses of midazolam and loading with a long acting agent (phenytoin,
levetiracetam, phenobarbitone)
7. Signs of raised
intracranial pressure
8. Unconsciousness with worse
than flexion motor response
9. Any arrhythmia
with haemodynamic compromise (shock*, hypotension, signs of heart failure)
10. Any child with suspected systemic to pulmonary shunt who is about to be intubated or needing inotropes
11. Any child with suspected
cardiomyopathy / myocarditis who is about to be intubated or needing inotropes
12. Cardiac or respiratory arrest
13. Serum ammonia
>150 mcg/dL
Any child
fulfilling these Go Now criteria should be discussed urgently with a PIPER
consultant. Most of these children will need to be
transported out by PIPER to RCH PICU or Monash PICU, but some will initially be
stabilised in the regional ICU that has a paediatric intensive care section.
* Signs of shock include capillary refill >3 seconds, low volume pulses, hypotension, tachypnoea, lethargic or poor conscious state.