Pharmacologic support of infants and children in septic shock.
OBJECTIVE
Septic shock (SS) is a frequent cause for admission to the pediatric intensive care unit, requiring prompt recognition and intervention to improve outcome. Our aim is to review the relevant literature related to the diagnosis and management of SS and present a sequential management for its treatment.


METHODS
Non-systematic review of medical literature using the MEDLINE database. Articles were selected according to their relevance to the objective and according to the authors' opinions.


RESULTS
The outcome of sepsis and SS is dependent on the early recognition and implementation of time-sensitive goal-directed therapies. These include rapid aggressive fluid resuscitation followed by a well-designed pharmacotherapy. The goals of the resuscitation are the restoration of microcirculation and improved organ tissue perfusion. Clinical and laboratory markers are needed to assess the adequacy of the treatments. Altered pharmacokinetic and pharmacodynamic responses dictate that vasoactive agents should be adjusted to achieve the predetermined goals. In initial resuscitation with isotonic solutions (> 60 mL/kg), either crystalloid (normal saline) or colloid infusion could be used. Despite adequate fluid resuscitation, if: (a) wide pulse pressure, low blood pressure, or bounding pulses (high cardiac output, low systemic vascular resistance--SVR) are present, norepinephrine should be considered; (b) prolonged capillary refill, weak pulses, narrow pulse pressure, normotensive (low cardiac output, high SVR), dopamine, epinephrine or dobutamine should be considered. Adjunctive therapy with stress dose of corticosteroid is indicated in selected populations.


CONCLUSIONS
Septic shock hemodynamics is a changing process that requires frequent assessment and therapeutic adjustments.
Irazuzta
José
J
Pediatric of Critical Care Medicine, Health Science Center, University of Florida, Jacksonville, FL, USA. jose.irazuzta@jax.ufl.edu
Sullivan
Kevin J
KJ
Garcia
Pedro Celiny R
PC
Piva
Jefferson Pedro
JP
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002648:Child; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D012151:Resuscitation; D012772:Shock, Septic / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D014662:Vasoconstrictor Agents