Department of Pediatrics, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India.
Department of Pediatrics, All India Institute of Medical Sciences, Room 3055, Ansari Nagar, New Delhi, 110029, India.
Indian J Pediatr. 2023 Mar;90(3):280-288. doi: 10.1007/s12098-022-04434-3. Epub 2023 Jan 30.
Shock in children is associated with significant mortality and morbidity, particularly in resource-limited settings. The principles of management include early recognition, fluid resuscitation, appropriate inotropes, antibiotic therapy in sepsis, supportive therapy for organ dysfunction, and regular hemodynamic monitoring. During the past decade, each step has undergone several changes and evolved as evidence that has been translated into recommendations and practice. There is a paradigm shift from protocolized-based care to personalized management, from liberal strategies to restrictive strategies in terms of fluids, blood transfusion, ventilation, and antibiotics, and from clinical monitoring to multimodal monitoring using bedside technologies. However, uncertainties are still prevailing in terms of the volume of fluids, use of steroids, and use of extracorporeal and newer therapies while managing shock. These changes have been summarized along with evidence in this article with the aim of adopting an evidence-based approach while managing children with shock.
儿童休克与较高的病死率和发病率相关，在资源有限的环境下尤其如此。其治疗原则包括早期识别、液体复苏、应用合适的正性肌力药物、脓毒症时使用抗生素、针对器官功能障碍的支持治疗，以及定期进行血流动力学监测。在过去十年中，每一步都经历了许多变化，这些变化都被转化为推荐意见和临床实践，休克的治疗理念也从基于方案的治疗转变为个体化管理，从液体、输血、通气和抗生素的宽松策略转变为限制策略，从临床监测转变为使用床边技术的多模式监测。然而，在休克管理中，液体量、类固醇的使用、以及体外和新型治疗的应用等方面仍存在许多不确定性。本文对这些变化及相关证据进行了总结，旨在为儿童休克的管理提供循证方法。
