Recommendations for the management of pediatric septic shock in the first hour (part one).

In the past two years, different organizations have updated their clinical practice guidelines for hemodynamic support in pediatric septic shock. The studies conducted in adults have questioned the initial management of sepsis in accordance to protocols based on achieving various goals. However, the usefulness of these protocols in children has been demonstrated. The possibility of adhering to guidelines may vary depending on patients and facilities, so it is necessary to update the general aspects of initial care for children with sepsis. The proposal is to shift the paradigm from an "individual practice guideline," which is universal for all, to an "institutional practice guideline" and to assess the factors that should be improved at each facility. This manuscript is divided into two parts. The first part analyzes the bundles for the early detection of septic shock. Part two addresses treatment, stabilization, referral, and process analysis.