develops, profound instability and cardiovascular collapse may soon
ensue.
15 - 45 minutes: Assess for response to therapy and escalate if
fluid refractory shock persists. Without presence of more invasive
monitoring, initial therapy is titrated to normalization of blood pressure
or distal perfusion, as manifested by improved capillary refill and
peripherally pulses, resolution of oliguria, and improvement in mental
status. If the response to fluid is poor, care needs to be escalated and
inotropes started. Additional support, including placement of central
access and intubation will likely be necessary at this stage.
Septic pediatric patients may present in one of three ways: Low
cardiac output with high systemic vascular resistance (SVR) and
normal blood pressure, often termed “cold shock;” Low cardiac output,
high SVR, and hypotension, also considered “cold shock;” and low
cardiac output with low SVR, or “warm shock.”[ 11 ] Choice of inotrope
or other vasoactive drugs depends on the child’s state of shock: