Study of prevalence, etiology, response to treatment and outcome of paediatric shock in a tertiary care hospital

Abstract

Background: Shock accounts for 2% of children admitted to Paediatric casualty worldwide as per most western literature and in Nelson text book of Paediatrics. About 10 million children die of shock every year in the world. Highest mortality is observed in under 5 children in developing countries. Clinical manifestations are due to decreased perfusion to tissues, the compensatory mechanisms that are triggered by the decreased perfusion and the inadequate removal of metabolic wastes. This study was carried out to assess the prevalence of paediatric shock in children admitted to Paediatric ICU, to identify possible aetiology and the response to treatment and outcome in patients admitted with shock in Paediatrics Department of Government Mohan Kumaramangalam Medical College, Hospital, and Salem.Methods: All sick children admitted to Paediatric intensive care unit of Government Mohankumaramangalam Medical College Hospital, Salem with the suspicion of shock are assessed by using the rapid cardiopulmonary assessment and diagnosed suffering from shock. Possible etiology, type and severity of shock would be arrived at using a targeted history, clinical examination and relevant laboratory investigations.Results: All children who had unstable airway or bradypnea, were having decompensated shock and except one among them all expired despite prompt airway management. Respiratory distress noticed in 23 (40.4%) of children and all of them had either cardiogenic, septic shock or a combination of both. Capillary refill time was prolonged in 52 (91.2%) of children and the remainder 5 (8.8%) had flash refill and managed as warm septic shock. Decompensated shock as evidenced by low blood pressure was seen in 57.9% children. All of them had altered mental status. Urinary output was monitored in 38 children of which 31 (81.6%) had oliguria.Conclusions: Septic shock accounts for majority of decompensated shock and poor outcome to management. Infancy decompensated shock, septic shock and those requiring ventilator support were the factors influencing the outcome of management.

Clinical profile and outcome of children with shock admitted at a tertiary hospital in Addis Ababa

“…Our observation related to Septic shock prevalence which is 32.2% of the total shock patients is in contrast with the reports from India which showed septic shock was the commonest [10,11]. Again, this could be due to the difference between the settings of the studies.…”

“…Comparable outcome was also reported by Vasundhara et.al, 2017 [10]. Mortality rate in our study among septic shock patients is 50% similar high mortality rate was also reported by other studies [5,10,11,14].…”

“…This is also supported by the nding in 14 Kenyan hospitals and also by a study done by Singh et.al [6,8]. On the contrary lower prevalence of hypovolemic shock was reported in two studies done in India [10,11]. This difference may be seen because the later studies were conducted in an ICU.…”

“…Unlike other studies normal range temperature, oxygen saturation, capillary re ll time, urine output and blood glucose level are observed in majority of shock patients in this study. This variation in clinical ndings between the present study and reports from other literatures could be attributed to the difference in etiologies of shock [8,10,11,14] Multiple organ failure is a sequential and progressive organ dysfunction often occurring in a predictable sequence. In our study multiple organ failure was present in 7 cases (22.6%).…”

A prospective observational study on assessment of types of shock in children and requirement of inotropes in treatment of shock in tertiary care hospital

“…5 All children with shock must be administered high flow oxygen as there is tissue hypoxia. 6 Rapid boluses of RL or NS at 20 mi/kg in 5-10 mm are given. 7 In patients with fluid refractory shock, pharmacological support using vasoactive amines is a choice of treatment.…”