Introduction: Fluid refractory septic shock in adults is predominantly caused by vascular failure and is rarely a result of low cardiac output [Critical Care Clinics, Vol 13 (3) 1997]. Therefore the use of inotropes and vasodilators is uncommon. We hypothesized that, unlike adults, children with fluid refractory septic shock have a high incidence of low cardiac output and high vascular resistance which responds to inotrope and vasodilator therapy. Methods: 49 consecutive children with septic shock refractory to 60 cc/kg volume resuscitation (with pulmonary artery catheters and PCWP > 8 cm H2O for the first 48 hours) were examined for use of inotropes and vasodilators to increase cardiac index (CI) to > 3.3 < 6.0 1/min/m2, and decrease systemic vascular resistance (SVRI) to < 1600 dyne-sec5/m2 and reverse shock. Values = mean +/- SEM. Statistics = Fisher Exact Test for increase in new therapy over time. Results: Overall, 45 of 49 children received inotropes and 2 lof 49 received vasodilators. The predominant profile at presentation was the low cardiac output and high vascular resistance state. 28 of 49 children needed inotropic therapy (7 with a vasodilator) to reverse shock and maintain cardiac output (post therapy CI = 3.38 +/0.21and SVRI= 1552.52+/-114.14). Over 48 h, 11 more children in this group needed the addition of a vasodilator to reverse persistent shock and improve cardiac output (p < 0.05). Only 10 of 50 children showed the "classic adult high output state" and needed only vasopressor support to reverse shock at presentation (post therapy CI = 5.81 +/- 0.58 and SVRI 935 +/-131.5); however, 6 of these children needed the addition of an inotrope over 48 h for decreasing cardiac output and persistent shock (p < 0.05). 11 of 49 children needed inotropes and vasopressors to reverse fluid refractory shock from the time of presentation. Conclusion: Contrary to adult reports, the low CI and high SVRI state is prevalent in fluid refractory pédiatrie septic shock. The use of inotropes and vasodilators should be considered in children with fluid refractory and persistent septic shock. 3M01RR0056.
|Original language||English (US)|
|Journal||Critical care medicine|
|Issue number||1 SUPPL.|
|State||Published - Dec 1 1998|
All Science Journal Classification (ASJC) codes
- Critical Care and Intensive Care Medicine