Keep in mind that vasodilation may cause hypotension, and needs
to be added in conjunction with volume loading and continued
monitoring. Both phosphodiasterase inhibitors (mirlinone and
imrinone), and calcium channel sensitizers such as levosimendan
have been used, as well as nitrovasodilators.- For cold shock with hypotension, initial resuscitative targets are
similar: Titrate fluids/inotropes to ScVO 2 >70% and Hgb >10g/dl. If
shock persists, add norepinephrine and if ScVO 2 still remains
<70%, consider adding dobutamine, or other vasodilators
discussed above - Warm shock with hypotension. Initial resuscitative targets are as
above. If ScvO2 still remains low, adding vasopressin, terlipressin
or angiotensin may be helpful, as well as low dose epinephrine.
If despite all of the above, patient remains unstable, hypotensive, and otherwise
unresponsive to therapy, ECLS should be considered. Rationale for use of
ECMO and other adjunct to pediatric sepsis therapy are further discussed in the
next section.