Background: The clinical syndrome of shock, a clinical state characterized by inadequate tissue perfusion, is one of the most dramatic, dynamic and life-threatening problems faced by the physician in the critical care setting. Methods: This retrospective observational study analysed all critically ill children aged 1 month to 12 years who were admitted to our hospital’s Pediatric Intensive Care Unit (PICU) between January 2023 and December 2023, requiring mechanical ventilation and presenting with clinical evidence of shock. The majority of deaths in this cohort were attributed to decompensated shock. The Paediatric Index of Mortality 3 (PIM3) score was calculated for each patient to evaluate the severity of illness and predict outcomes. The authors meticulously documented the patterns of morbidity and mortality across different types of shock and assessed the outcomes in the PICU. All collected data were systematically compiled and tabulated for comprehensive analysis. Results: The frequency of shock in our PICU was 2.1% (n=257). However, among mechanically ventilated patients it was present in 104.31 patients. Septic shock was the most commonly encountered shock (62.6%). Out of 186 cases, 125 survived (67.2%), 61 died (32.8%). Shock had no correlation with PIM3 score and mortality. Conclusions: Shock is a significant cause of morbidity and mortality in children, especially those under 5 years of age. In our study, septic shock was identified as the most prevalent form of shock, with severe pneumonia being the leading cause. We found that mortality rates were higher in patients who required prolonged mechanical ventilation. To improve outcomes and management strategies, larger prospective multicentric studies in developing countries are highly recommended.