Hemodynamic Support in Fluid-refractory Pediatric Septic Shock

Abstract

Unlike adults, children with fluid-refractory shock are frequently hypodynamic and respond to inotrope and vasodilator therapy. Because hemodynamic states are heterogeneous and change with time, an incorrect cardiovascular therapeutic regimen should be suspected in any child with persistent shock. Outcome can be improved compared with historical literature.

Perfil clínico da resposta inflamatória sistêmica após cirurgia cardíaca pediátrica com circulação extracorpórea

“…Unlikely the shock in adults, the shock in children presents a singularity: in 80% of occurrences it is associated with myocardial dysfunction 27 . Postoperatively, the low cardiac output syndrome is described in approximately 24% of newborns submitted to Jatene procedure and is characterized by myocardial dysfunction and decrease in cardiac output, both associated with an increase in CPB is followed by acute respiratory distress in a 0.4% frequency in the adult population with associated mortality 21 .…”

Shock séptico en pediatría II: Enfoque actual en el diagnóstico y tratamiento

“…Sin embargo, si persiste el shock, su respuesta hemodinámica es distinta a la descrita en adultos caracterizándose por un bajo gasto cardíaco (GC), hipodébito y elevada resistencia vascular, de manera que es la disponibilidad de oxígeno (oxygen delivery, DO 2 ) y no su extracción (oxygen consumption, [VO 2 ]/DO 2 ), el principal determinante del consumo de oxí-geno. Aproximadamente el 50% de los niños presentan este patrón hemodinámico el cual es conocido como SS frío [6][7][8] .…”

“…La droga de elección es la dopamina. No obstante, Ceneviva et al 7 , demostraron que los niños con shock refractario a fluidos, presentan distintos patrones hemodinámicos, incluyendo GC bajo/ Resistencia Vascular Sistémica (RVS) elevada (60%), GC bajo/RVS baja (20%) y GC elevado/RVS baja (20%), por lo tanto, la elección de la droga a utilizar va a depender del patrón predominante. De la misma manera, Irazuzta et al 62 , insisten en estas diferencias y proponen usar vasopresores, inótropos y/o vasodilatadores en función de la condición hemodinámica del niño (SS frío o caliente).…”

What’s New in the Recognition and Management of Septic Shock in Children: Dos and Don'ts

“…Given the wide range of potential pathogens and the range of host responses, it is inevitable that there will be a range of clinical features related to septic shock. This is further complicated by the range of hemodynamics [25,26] encountered in children with septic shock. In a recent study of patients with fluid resistant (who required 40 mL/kg or more of resuscitation) septic shock [27], patients with central-line-associated infection (predominantly Staphylococcus epidermidis and Klebsiella pneumoniae) presented with high cardiac output and low systemic vascular resistance while patients with community acquired sepsis presented with low or normal cardiac output and high systemic vascular resistance.…”