Abstract
Septic shock and cardiogenic shock are the two most common types of shock in children admitted to pediatric intensive care units (PICUs). The aim of the study was to investigate which hemodynamic variables were associated with mortality in children with shock. We retrospectively analyzed 50 children with shock (37 septic shock cases and 13 cardiogenic shock cases) in the PICU and monitored their hemodynamics using transpulmonary thermodilution from 2003 to 2016. Clinical factors were analyzed between the patients with septic and cardiogenic shock. In addition, hemodynamic parameters associated with mortality were analyzed. The 28-day mortality was significantly higher in the septic group than in the cardiogenic group (p = 0.016). Initially, the parameters of cardiac output and cardiac contractility were higher in the septic group (p < 0.05) while the parameters of preload and afterload were all higher in the cardiogenic group (p < 0.05). Cardiac index was significantly lower in the nonsurvivors of cardiogenic shock at the time of initial admission and after the first 24 hours (both p < 0.05), while systemic vascular resistance index (SVRI) was significantly lower in the nonsurvivors of septic shock (p < 0.001). Therefore, during the first 24 hours after intensive care, SVRI and cardiac index are the most important hemodynamic parameters associated with mortality.
Highlights
Circulatory shock causes mortality in children and accounts for one-third of cases in intensive care units (ICUs) [1, 2]
Hemodynamic monitoring is essential for the diagnosis and therapeutic management of critically ill patients
During the 13-year study period, 52 children with septic or cardiogenic shock monitored using the PiCCO system were gathered; two cases were excluded owing to insufficient data
Summary
Circulatory shock causes mortality in children and accounts for one-third of cases in intensive care units (ICUs) [1, 2]. Septic shock and cardiogenic shock are the two most common types accounting for three-fifth and one-fifth of the shock population, respectively, in ICUs [1, 2]. Some studies reported that the mortality rate was ∼40 to 80% in septic shock and 60% in cardiogenic shock [3, 4]. Delay in the management and recognition of potential clinical symptoms/signs of compensated shock could lead to a high mortality rate [5]. Timely interventions to maintain an adequate tissue perfusion and oxygenation could significantly decrease the morbidity and mortality in children admitted to ICUs [6, 7]. Hemodynamic monitoring is essential for the diagnosis and therapeutic management of critically ill patients
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