DOI: https://doi.org/10.22141/2224-0586.4.91.2018.137850

Hemodynamic support in pediatric septic shock. Discussions questions in view of the recent consensus

M.А. Heorhiants, V.А. Коrsunov

Abstract


Septic shock remains a leading cause of mortality and morbidity in children. There is ongoing uncertainty regarding the optimal treatment pathways; however, the initial management of sepsis is crucial. This article is designed to be an informal review of recent developments in pediatric sepsis hemodynamic support. The Surviving Sepsis Campaign and the American College of Critical Care Medicine Guidelines for hemodynamic support in neonates and children remain the most recognized standards of care. The objectives of these recommendations were to standardize patient’s care and further to reduce mortality and morbidity in pediatric sepsis. These guidelines represent best clinical practice; however, stronger evidence is lacking to confirm the components of these guidelines; almost all levels of references and recommendations in pediatric septic shock treatment are low. The article describes some commonly used inotropes and vasoactive agents in pediatric patients with septic shock. Depending on distinct pharmacological properties, their effects on vascular bed and cardiac function are different. For example, dopamine has equivalent effect on heart and vasculature, which can result in increase in cardiac output, mean arterial pressure and heart rate. Dobutamine is considered as inodilator because it has potent effect on cardiac systole and vasculature. Patients with sepsis and septic shock sometimes have coexisting cardiac dysfunction that justifies the use of dobutamine. Levosimendan is a relatively new agent exerting its inodilator effect by increasing sensitivity of myo­cardium to calcium. Authors proposed the optimal inotrope, vasopressor and vasoactive treatment in Ukrainian pediatric critical care unit.

Keywords


children; septic shock; hemodynamic support; critical care

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