Annane D, Siami S, Jaber S, Martin C, Elatrous S, Declère AD Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients: the CRISTAL randomized trial. JAMA. 2013; 310:(17)1809-1817

Badheka A, Bangalore Prakash P, Allareddy V. Successful use of extracorporeal membrane oxygenation in a child with obstructive shock due to massive bilateral pulmonary embolism. Perfusion. 2018; 33:(4)323-325

Bedford Russell AR. Neonatal sepsis. Paediatrics and Child Health. 2015; 25:(6)271-275

Bentley J, Henderson S, Thakore S, Donald M, Wang W. Seeking sepsis in the emergency department-identifying barriers to delivery of the sepsis 6. BMJ Qual Improv Rep.. 2016; 5:(1)

Bersten AD, Soni N. Oh's intensive care manual, 5th edn. London: Elsevier; 2003

Brissaud O, Botte A, Cambonie G Experts' recommendations for the management of cardiogenic shock in children. Ann Intensive Care. 2016; 6:(1)

Crisp S, Rainbow J. Emergencies in paediatrics and neonatology.Oxford: Oxford University Press; 2007

Dellinger RP, Levy MM, Carlet JM Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008; 34:(1)17-60

Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004; 27:(350)2247-2256

Friedman ML, Bone MF. Management of pediatric septic shock in the emergency department. Clin Pediatr Emerg Med. 2014; 15:(2)131-139

Fuhrman BP, Zimmerman JJ. Pediatric critical care.Philadelphia (PA): Elsevier; 2006

Grosvenor MB, Smolin LA. Nutrition: everyday choices.New York: John Wiley and Sons; 2006

Jevon P. Paediatric advanced life support: A practical guide for nurses.Chichester: Wiley-Blackwell; 2012

McVea S, Turner A. Which vasoactive drug should be first choice in paediatric septic shock?. Arch Dis Child. 2019; 104:(3)303.1-305

Plunkett A, Tong J. Sepsis in children. BMJ. 2015; 350

Resuscitation Council (UK). Guidelines and guidance. 2015. (accessed 3 March 2020)

Waltzman ML. Pediatric shock. J Emerg Nurs. 2015; 41:(2)113-118

Weiss SL, Keele L, Balamuth F Crystalloid fluid choice and clinical outcomes in pediatric sepsis: a matched retrospective cohort study. J Pediatr. 2017; 182:304-310.e10

Understanding shock in children

26 March 2020
Volume 29 · Issue 6

Shock is an unstable physiological state that occurs following acute failure of the circulation, which results in inadequate tissue perfusion and oxygenation and incomplete removal of harmful metabolic waste products. Shock leads to a decrease in intravascular volume, a disruption to circulating intravascular volume, or impaired cardiovascular function (Waltzman, 2015). Recognising shock can be difficult as the signs and symptoms of shock are not those of the underlying disease/process, but the body's attempts to maintain homeostasis by preserving an effective circulation (Cameron et al, 2019). If shock is not recognised, anaerobic metabolism and tissue acidosis will result; if these changes are not reversed, end organ failure will follow (Crisp and Rainbow, 2007).

In this article, ‘children’ will refer to any child or young person up to 16 years of age. However, although infection is recognised as the leading cause of mortality and morbidity in the newborn (Bedford Russell, 2015), early-onset neonatal infection will not be discussed. Shock is classified in many ways, describing the physiological response to the underlying cause. Waltzman (2015) identified the three classifications for shock as hypovolaemic, distributive and cardiogenic; Cameron et al (2019) added obstructive and dissociative to total five classifications. Although these classifications support an understanding of the underlying cause of shock, an alternative approach is to consider how the child's circulation is compromised. For an effective circulation the child requires three essential components: fluid to transport oxygen and remove metabolic waste (blood), a pump to circulate the fluid (the heart), and vessels (arteries/veins) to contain the fluid.

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