New Phoenix criteria for pediatric sepsis and septic shock: the strengths and the future of a comprehensive perspective

In Greek mythology, the phoenix bird symbolizes life that overcomes death and the strength that accompanies transformation. Therefore, Phoenix is an appropriate name for the new Pediatric Sepsis Score owing to both the mythological reference and the location where it was first presented (Society of Critical Care Medicine – SCCM - Conference in Phoenix, Arizona). (1) The Phoenix Pediatric Sepsis (PPS) criteria for sepsis and septic shock are intended to identify children (1 month to <18 years) with life-threatening organ dysfunction due to infection, and the score was developed based on more than three million pediatric electronic health encounters, (2) which is a remarkable achievement considering pediatric and adult sepsis studies. The previous pediatric sepsis criteria were published in 2005 by the International Pediatric Sepsis Consensus Conference (IPSCC), and sepsis was defined as a suspected or confirmed infection in the presence of systemic inflammatory response syndrome (SIRS) (Figure 1). (3) Although these criteria are broadly used in daily practice, limitations to this definition have been identified since its inception. (4) Specific limitations of concern include a lack of consideration of a global context, leading to challenges in the applicabiblity of these criteria in limited-resource settings where the highest sepsis burden lies; variability in application at the bedside, which leads to delay in patient diagnosis; and the inability to