[Septic shock in intensive care units. Current focus on treatment].
Essential therapeutic principles in children with septic shock persist over time, although some new concepts have been recently incorporated, and fully awareness of pediatricians and intensivists is essential. Fluid resuscitation is a fundamental intervention, but the kind of ideal fluid has not been established yet, as each of these interventions has specific limitations and there is no evidence supportive of the superiority of one type of fluid. Should septic shock persists despite adequate fluid resuscitation, the use of inotropic medication and/or vasopressors is indicated. New vasoactive drugs can be used in refractory septic shock caused by vasopressors, and the use of hydrocortisone should be considered in children with suspected adrenal insufficiency, as it reduces the need for vasopressors. The indications for red blood cells transfusion or the optimal level of glycemia are still controversial, with no consensus on the threshold value for the use of these blood products or the initiation of insulin administration, respectively. Likewise, the use of high-volume hemofiltration is a controversial issue and further study is needed on the routine recommendation in the course of septic shock. Nutritional support is crucial, as malnutrition is a serious complication that should be properly prevented and treated. The aim of this paper is to provide update on the most recent advances as concerns the treatment of septic shock in the pediatric population.
Programa de Medicina Intensiva en Pediatría, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.
Daniela
D
Arriagada S
Programa de Medicina Intensiva en Pediatría, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, Chile; Área de Cuidados Críticos, Unidad de Gestión Clínica de Niño, Hospital Padre Hurtado, Santiago, Chile. Electronic address: adonosofuentes@gmail.com.
Alejandro
A
Donoso F
Área de Cuidados Críticos, Unidad de Gestión Clínica de Niño, Hospital Padre Hurtado, Santiago, Chile; Centro de Investigación de Medicina Veterinaria, Escuela de Medicina Veterinaria, Facultad de Ecología y Recursos Naturales, Universidad Andrés Bello, Santiago, Chile.
Pablo
P
Cruces R
Área de Cuidados Críticos, Unidad de Gestión Clínica de Niño, Hospital Padre Hurtado, Santiago, Chile.
Franco
F
Díaz R
D000309:Adrenal Insufficiency / Q000628:therapy; D002648:Child; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use; D007362:Intensive Care Units; D012772:Shock, Septic / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D006854:Hydrocortisone
Control glucémico; Glycemic control; Hemofiltración de alto volumen; High-volume hemofiltration; Inotropes; Inótropos; Sepsis; Septic shock; Shock séptico