الفهرس 
ContentsOnly 14 pages are availabe for public view
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Abstract
Septic shock in children is associated with high mortality and morbidity. Its management is time-sensitive and must be aggressive and target oriented. The use of clinical assessment alone to differentiate between cold and warm shock and to select the appropriate management is fraught with errors with up to 66% of shock diagnosed as being cold shock by experienced clinicians were found to have vasodilation by invasive measurement. We tried through our prospective observational study to evaluate hemodynamic changes which occur during septic shock using noninvasive cardiometry in order to assess pathophysiology of septic shock in infants and children and assess if the clinical examination alone is a good tool for accurate hemodynamic categorization of septic shock and assess if the clinical examination alone is a good indicator of fluid or inotrope responsiveness in management of pediatric septic shock. We included 90 patients of septic shock (44 male and 46 female) with mean age 21.36±9.4 months. We divided them according to clinical examination in to cold and warm shock and did basal EC monitoring to them and divided them in to VDEC (high CI, low SVRI) and VCEC (low CI, high SVRI) showing that 65 (72.2%) had a cold shock and the remaining 25 (27.7%) had a warm shock. However, on EC assessment, only 40 of the 65 patients with a clinical cold shock were determined to have VCEC shock. Among the other 25 patients, 15 had VDEC shock, while the other 10 had normal CI with high SVRI (>1600 dyn second/cm5/m2) and were included in the VCEC group for analysis. All the 25 children with clinical warm shock had VDEC shock. Thus, a total of 40 (44.4%) children had VDEC shock and 50 (55.5%) had VCEC shock. We then started management of septic shock according to ACCM/PALS guidelines giving fluid bolus up to 60 ml/kg until improvement or appearance of signs of volume overload. After every 20ml /kg, we assessed the patient clinically and measure hemodynamic variables with electrocardiometry. Conclusion : Noninvasive hemodynamic monitoring using electrocardiometry permits comprehensive hemodynamic categorization and assessment of fluid and inotrope responsiveness in pediatric septic shock. This may provide real-time guidance for optimal management. Categorization of pediatric septic shock based on the CI and SVRI into vasodilated or vasoconstrictive shock rather than clinical warm or cold shock may facilitate targeted resuscitation. Fortunately, our conclusion is the same as the most recent SSC guidelines which recommended not using bed side clinical signs in isolation to categorize septic shock in children as “warm” or “cold” and recommended using advanced hemodynamic variables, when available, in addition to bedside clinical variables to guide the resuscitation of children with septic shock or another sepsis-associated organ dysfunction.