New Methods of Monitoring Shock in Children

Abstract

Opinion statementShock in children is a cause of significant morbidity and mortality. Worldwide, most children dying from shock do not have the opportunity to benefit from advanced critical care support and we recommend to readers the World Health Organization ETAT guidelines [1]. For children treated in the intensive care environment, standard cardiovascular measures such as heart rate, pulse volume, perfusion/capillary refill, core-peripheral temperature gradient and blood pressure along with measures from other organ systems (e.g. urine output and consciousness level) remain vital. All are part of the global assessment of cardiovascular performance and shock in children, and none of the new techniques we describe replace the need for these assessments in critically ill children. Furthermore, evidence is lacking to mandate utilisation of any of the advanced methods we review and they should only be considered as adjuncts to the aforementioned assessments in critical care. We suggest that the optimal monitoring of the shocked child in the ICU, and those developing shock outside the ICU, should include measuring those hemodynamic parameters above together with assessment of preload responsiveness and organ perfusion. Early goal-directed therapy targeting shock reversal remains the consensus best practice position and includes optimization of several haemodynamic parameters [2]. Our personal practice remains to firstly target clearance of raised lactate and venous desaturation, measured by intermittent blood gas analysis and secondly to optimise preload, contractility and afterload guided by Doppler ultrasound or echocardiography. Both can be undertaken in both the emergency department as well as the ICU.

Fluid responsiveness in children with Septic shock is not a Reliable Predictor of outcome: Single Center Experience

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Ultrasound cardiac output monitoring in mechanically ventilated children

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Paediatric point‐of‐care ultrasound in a resource‐limited Melanesian setting: A case series

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