bladder pressures can be helpful in early recognition of intra-
abdominal hypertension, allowing for potential prevention of
ACS development.[ 12 - 13 ]
60 minutes: Treatment may be deescalated, based on the individual
patient response, but in cases of severe sepsis and shock, prolonged
therapy is generally necessary. Repeated examinations and close hands-
on attention to a septic child require ICU setting. In modern ICUs,
additional monitoring is helpful to guide goal directed therapy, avoid over-
resuscitation with excessive fluid overload, and minimize risk of ischemia
with use of vasoactive medications. In case of persistent shock, despite of
all of the already discussed measures, additional measures may be
necessary.
1. For cold shock with normotension: Titrate dopamine or
epinephrine and fluids to an ScVO 2 >70%. Keep Hgb >10g/dl in
the initial resuscitation. However, if stability is reached, Hct of >7
g/dl is acceptable and may limit unnecessary use of blood products.
If cold shock persists, treatment of vasoconstriction may improve
poor cardiac output and reversal of shock.[ 14 - 15 ]