Intensive Treatment of Septic Shock in Pediatric Practice

Abstract

In pediatric practice, septic shock (SS) is a serious, urgent condition with a high incidence and increased risk of death. Intensive therapy in this condition is based on provision of volume-expansion fluid management, prescription of antibiotic medications, and vasopressor support. Urgent care for children is provided in an intensive care unit and includes mandatory determination of the aetiology of SS (by inoculation of blood samples for sterility), provision of venous access and continuous monitoring of vital signs with measurement of lactate levels. The intensity of respiratory support changes according to the following stepwise logic: oxygen therapy – non-invasive ventilation – mechanical ventilation. When providing fluid management to a patient with SS, preference is given to crystalloid solutions. Antibacterial therapy is devised empirically and must be administered within the first hour of ICU admission. If fluid management proves insufficient to ensure stable hemodynamic parameters, vasopressor support is provided by administering inotropic agents, vasodilators and inodilators (norepinephrine, epinephrine, dopamine and dobutamine). Evidence on the effectiveness of corticosteroids in children and adolescents with SS is lacking. Knowledge of the latest algorithms of intensive treatment of SS in pediatric practice will enhance the quality of care and improve the therapeutic prognosis in this category of patients.