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Joseph A. Carcillo, MD

Dr. Carcillo's research career has been devoted to developing clinical practices which improve outcomes in children with Sepsis.  Children commonly get infections.  Antibiotics are effective for most of these infections.   Unfortunately, not uncommonly children are unable to keep their infections localized and controlled.  When infection spreads it can threaten their lives from ‘Sepsis’.  Children with sepsis breathe fast, have a fast heart rate, and do not feel well.  Dr.Carcillo's research has centered on developing better means of early recognition and early treatment.   No ‘one’ sign is effective for early recognition, and no ‘one’ therapy is effective for early treatment.  Instead a constellation of signs and stepwise use of bundles of therapies are most effective in improving outcomes in sepsis.  These signs and treatments can differ according to region of the world, access to resources, and types of infections. 

Dr.Carcillo is involved in local, national and international efforts to improve the care of children with sepsis. Carcillo's global effort is called the Global Pediatric Sepsis Initiative www.pediatricsepsis.org.  This is a web based educational, quality improvement, and instructional program sponsored by the World Federation of Pediatric Intensive and Critical Care Societies.  Members of the initiative learn from one another.  For example, in Southeast Asia a fluid bolus saves lives in children with hypovolemic Dengue Shock, but in Sub-Saharan Africa where severe anemia is prevalent, fluid boluses are harmful and instead blood is life-saving in children without hypotension.  Neither the children in Southeast Asia nor those in Sub Saharan Africa have access to oxygen, mechanical ventilation, inotropes or intravascular monitoring

In the resource rich environment such as ours, Dengue and severe anemia (with the exception of the sickle cell population) is mostly non-existent.  The resource rich children have access to oxygen, mechanical ventilation, inotropes, intravascular monitoring, extracorporeal support systems, and specialized transport services.  Infections are commonly bacterial, viral and fungal.  Hospitals in London and Rotterdam report reductions in mortality with meningococcemia from 22% to 2% with implementation of specialized transport and early resuscitation.  In a randomized trial in Brazil administration of bundled therapies directed to maintaining superior vena cava oxygen saturations > 70% reduced mortality 4 fold in children with bacterial and fungal infections.

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