Cureus · 2026
Clinicoetiological Profile and Outcomes of Shock in Mechanically Ventilated Children in a Pediatric Intensive Care Unit.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Agarwal Shivali, Rakholia Ritu, Nagarkoti Gunjan
Аннотация
INTRODUCTION: Shock in mechanically ventilated children is associated with severe circulatory failure, tissue hypoperfusion, multiorgan dysfunction, prolonged intensive care requirement, and high mortality. Early bedside recognition of hemodynamic instability is essential, particularly because hypotension may appear late in pediatric shock.
OBJECTIVES: To evaluate the clinicoetiological profile and outcomes of shock in mechanically ventilated children admitted to the pediatric intensive care unit (PICU), determine the common type of shock, assess morbidity and mortality, identify factors associated with poor outcome, and determine the duration of shock reversal.
METHODS: This prospective observational study included 120 children aged one month to 16 years who were admitted to the PICU over an 18-month period. Children with clinical evidence of shock requiring mechanical ventilation were enrolled by consecutive sampling after parental consent. Sociodemographic data, clinical features, vital parameters, Pediatric Age-Adjusted Shock Index (SIPA), laboratory parameters, etiological diagnosis, shock type, treatment profile, and outcomes were analyzed.
RESULTS: Among 120 children, 63 (52.5%) survived, and 57 (47.5%) expired. Infants below one year formed the largest subgroup (40, 33.3%), and males predominated (77, 64.2%). Septic shock was the most common shock type (104, 86.7%), and respiratory infection/pneumonia/acute respiratory distress syndrome was the leading etiology (48, 40.0%). Younger age, decompensated shock, shock duration >4 hours, blood pressure below the 5th centile, higher mean SIPA, altered sensorium, pallor, cyanosis, edema, thrombocytopenia, deranged coagulation, raised transaminases, hyperlactatemia, requirement of multiple inotropes, transfusion requirement, and mechanical ventilation >72 hours were significantly associated with mortality.
CONCLUSION: Septic shock secondary to severe respiratory infection was the predominant etiology and major contributor to mortality among mechanically ventilated pediatric shock patients. Hemodynamic instability, persistent hypoperfusion, organ dysfunction, and prolonged intensive care support were important markers of poor outcome. Early recognition using bedside hemodynamic assessment, including SIPA, protocol-based resuscitation, timely vasoactive therapy, and aggressive management of sepsis may improve survival.
OBJECTIVES: To evaluate the clinicoetiological profile and outcomes of shock in mechanically ventilated children admitted to the pediatric intensive care unit (PICU), determine the common type of shock, assess morbidity and mortality, identify factors associated with poor outcome, and determine the duration of shock reversal.
METHODS: This prospective observational study included 120 children aged one month to 16 years who were admitted to the PICU over an 18-month period. Children with clinical evidence of shock requiring mechanical ventilation were enrolled by consecutive sampling after parental consent. Sociodemographic data, clinical features, vital parameters, Pediatric Age-Adjusted Shock Index (SIPA), laboratory parameters, etiological diagnosis, shock type, treatment profile, and outcomes were analyzed.
RESULTS: Among 120 children, 63 (52.5%) survived, and 57 (47.5%) expired. Infants below one year formed the largest subgroup (40, 33.3%), and males predominated (77, 64.2%). Septic shock was the most common shock type (104, 86.7%), and respiratory infection/pneumonia/acute respiratory distress syndrome was the leading etiology (48, 40.0%). Younger age, decompensated shock, shock duration >4 hours, blood pressure below the 5th centile, higher mean SIPA, altered sensorium, pallor, cyanosis, edema, thrombocytopenia, deranged coagulation, raised transaminases, hyperlactatemia, requirement of multiple inotropes, transfusion requirement, and mechanical ventilation >72 hours were significantly associated with mortality.
CONCLUSION: Septic shock secondary to severe respiratory infection was the predominant etiology and major contributor to mortality among mechanically ventilated pediatric shock patients. Hemodynamic instability, persistent hypoperfusion, organ dysfunction, and prolonged intensive care support were important markers of poor outcome. Early recognition using bedside hemodynamic assessment, including SIPA, protocol-based resuscitation, timely vasoactive therapy, and aggressive management of sepsis may improve survival.