Abstract
Septic shock remains a major cause of morbidity and mortality among children, mainly due to acute hemodynamic compromise and multiple organ failures. In the last decade, international guidelines for the management of septic shock, as well as clinical practice parameters for hemodynamic support of pediatric patients, have been published. Early recognition and aggressive therapy of septic shock, by means of abundant fluid resuscitation, use of catecholamines and other adjuvant drugs, are widely considered of pivotal importance to improve the short and long-term outcome of these patients. The aim of this paper is to summarize the modern approach to septic shock in children, particularly in its very initial phase, when pediatric healthcare providers may be required to intervene in the pre-intensive care unit setting or just on admission in the pediatric intensive care unit.
Highlights
International Surviving Sepsis Campaign, and clinical practice parameters released by the American College of Critical Care Medicine (ACCM) for hemodynamic support of paediatric and neonatal septic shock have been published and recently updated.[8,9,10,11]
The aim of this paper is to summarize the modern approach to septic shock in children in its very initial phase, emphasising the pivotal role of early recognition and prompt management of this life-threatening condition, in PICU and in the pre-ICU setting
In patients with fluid refractory, catecholamine resistant shock, intermittent or n continuous infusions of hydrocortisone, rango ing from 1 up to 50 mg/kg/day is recommended within 60 min of diagnosis of shock.[9,11] se Other therapies for acute management of septic shock u Beyond the first hour of treatment, several l adjuvant therapies, including vasopressin, teria lipressin, levosimendan, milrinone, immunoglobulins, and protein C concentrate, have rc been attempted in pediatric septic shock, even e though evidence to support their use are still lacking.[9,11,20,21,22,23,24] m children with septic shock scarcely responding to initial aggressive treatments m must be suspected to have unrecognized moro bidities, including pericardial effusion, pneumothorax, ongoing blood loss, hypoadrenalism
Summary
Shock is a complex clinical syndrome caused by an acute failure of circulatory function, with inadequate tissue and organ perfusion, where delivery of oxygen and substrates to body tissues, as well as removal of metabolic waste products are inadequate. Shock is the common endism can precipitate severe sepsis and septic shock, including bacteria, viruses, mycobacteria and fungi, especially in the immunocompromised host
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