الفهرس 
PathophysiologyOnly 14 pages are availabe for public view
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Abstract
Sepsis, a syndrome of physiologic, pathologic, and biochemical abnormalities induced by infection, is a major public health concern with mortality about 50% when complicated by septic shock. In Egypt, infection accounts for 33% of deaths under 5 years of age. Definition of sepsis had developed along last 30 years. Recentlly sepsis is recognized as life-threatening organ dysfunction caused by a dysregulated host response to infection. This new definition emphasizes the primacy of the non-homeostatic host response to infection, the potential lethality that is considerably in excess of a straightforward infection, and the need for urgent recognition.
Clinical assessment of critical ill patient includes head to toe evaluation and assessment of vital signs. Putting some vital data together or analysis of vital data from prospect other than usual may help in clinical diagnosis. Shock index (SI) is good example for this. The shock index is a bedside assessment defined as heart rate (HR) divided by systolic blood pressure (SBP), It reflects both vascular and myocardial dysfunction and, thus, is an indicator of tissue perfusion. Shock index in infancy and young children calculated with normal ranges above that for the adults so, in pediatric, shock index ranges is defined by age adjusted shock index (SIPA). SIPA was defined by maximum normal HR and minimum normal SBP by age
Lactate production occurs in all tissues, even at baseline and under normal healthy oxygen rich conditions. In cardiogenic, hypovolemic or septic shock with tissue hypoxia there is usually an imbalance between the increased need of energy and ATP synthesis. This causes an increase in the glycolisis, resulting in a larger lactate production. A serum lactate in sepsis guidelines is one of the criteria that guide fluid therapy in shock. Normal lactate is up to 18- 20mg/dl, lactate more than 45 mg/dl is associated with more risk of mortality in sepsis.
This Analytical study conducted on 50 critically ill children admitted to PICU of Menoufia University Hospital from Jan 2015 to Dec 2016. Criteria for eligibility in this study included: (1) Age beyond the neonatal period up to 18 years. (2) Admission with severe sepsis or septic shock diagnosed according to last Pediatric Sepsis Consensus Conference criteria. (3) Parental consent. The exclusion criteria included: (1) Patients in the neonatal period or those older than 18-years old. (2) Lack of parental consent. (3) Patients suffering of chronic renal or hepatic disease. (4) Known cases of metabolic diseases (5) traumatic patients
For each patient, a complete diagnostic work-up was performed including thorough history and physical examination. Physical examination included: recording heart rate, respiratory rate and blood pressure. Routin laboratory Work-up and blood culture obtained on admission. In addition, a severity score was calculated using the Pediatric Risk of Mortality (PRISM) score from the website: http://www.sfar.org/scores2/prism2.php within 24 hours of admission.
Blood pressure measured by oscillatory method with 3 records in each time. HR measured by 5 lead ECG monitor. Age specific shock index was calculated by HR/SBP at 0,6,12 and 24 of admission. Lactate was measured at same points from peripheral venous sample by photometer. Patients were classified into 2 groups according to survival during admission (survivors and non survivors). The death was the primary outcome in this study. Data entry, coding, and analysis were undergone using PSW (20), IBM Corp. Released 2011.