Current Pediatric Research

Purpose: Various challenges are involved in distinguishing and managing different types of pediatric septic shock, especially when it comes to selecting and titrating inotropes and vasoactive agents. A comprehensive non-invasive hemodynamic study may prove beneficial in improving outcomes, particularly in underserved settings.

We examined the frequency of both vasodilatory and vasoconstricted pediatric fluid-refractory septic shock, as well as the different hemodynamic characteristics associated with each type of shock.

Materials and Methods: This single-center prospective cohort study was conducted on 78 patients with fluid refractory septic shock who were admitted to the Pediatric Intensive Care Unit (PICU) at the children's hospital of Cairo university. Upon admission to the PICU, hemodynamic parameters were acquired using electrical cardiometry. Subsequently, the children were divided into two groups based on their condition: those experiencing vasodilatory shock and receiving norepinephrine, and those with vasoconstrictive shock, who were administered epinephrine and/or milrinone based on their blood pressure and hemodynamic data. The patient's progress was monitored for 24 hours.

Results: Out of these patients, 43.60% (34 children) had vasodilatory septic shock, while the rest experienced vasoconstricted shock. Patients with vasodilatory shock demonstrated significantly higher contractility index, cardiac index, and stroke volume (p<0.001). Additionally, their thoracic fluid content and left ventricular ejection time were notably higher (p<0.001 and p=0.002, respectively) compared to those with vasoconstricted shock. The Pediatric Index of Mortality (PIM) 2 score was found to be a more reliable predictor of survival than the cardiac index and systemic vascular resistance.

Conclusion: In conclusion, this study highlights a significant occurrence of pediatric vasodilatory septic shock. Non-invasive hemodynamic assessment could assist in the effective selection of both inotropes and vasopressors, thus improving resuscitation success rates.

Author(s): Radwa Sayed Iraqy*, Bassem Saad, Nabil Mohsen Abdelaziz, Yasser Nassef, HebatAllah Fadel Algebaly, Mostafa Tawfik, Ola Youis, Elshimaa Salah Ahmed

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