Early recognition and treatment of pediatric shock, regardless of cause, decreases mortality and improves outcome. In addition to the conventional parameters (eg, heart rate, systolic blood pressure, urine output, and central venous pressure), biomarkers and noninvasive methods of measuring cardiac output are available to monitor and treat shock. This article emphasizes how fluid resuscitation is the cornerstone of shock resuscitation, although the choice and amount of fluid may vary based on the cause of shock. Other emerging treatments for shock (ie, temperature control, extracorporeal membrane oxygenation/ventricular assist devices) are also discussed.
Key points
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Shock is the proximate cause of death for many childhood diseases that cause significant mortality worldwide.
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Clinicians have always targeted vital signs to treat shock but new biomarkers and noninvasive cardiac output monitors are being increasingly used to diagnose, monitor, and predict outcome in pediatric shock.
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Early recognition and aggressive resuscitation have been shown to improve outcomes in pediatric shock.
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The choice of inotropes or vasopressor is largely dictated by the type of shock. The role of emerging therapies like hypothermia and ventricular assist devices needs to be delineated and the patient population whom they are likely to help needs to be identified further.
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