Article Data

  • Views 1738
  • Dowloads 177


Open Access

Pediatric Shock


1,Paediatric Intensive Care Unit Johns Hopkins affl. Anadolu Health Center

2Department of Pediatric Intensive Care Istanbul Faculty of Medicine, Istanbul University

DOI: 10.22514/SV31.042008.2 Vol.3,Issue 1,April 2008 pp.13-23

Published: 01 April 2008

*Corresponding Author(s): AYŞE AKCAN ARIKAN E-mail:


Millions of children die of shock due to various etiologies each year. Shock is a state of circulatory dysfunction where the metabolic demands of the tissue cannot be met by the circulation. Several different etiologies from hypovolemia to severe infection can result in shock. This review focuses on the definition of different types of shock seen in children and summarizes treatment strategies for the acute care practitioner based on pertinent recent literature. Early recognition and timely intervention are critical for successful treatment of pediatric shock. A strong index of suspicion by the treating clinician and early fluid resuscitation followed by ongoing assessment and timely transfer to a higher level of care can make the difference between life and death for the child who presents in shock. 


shock, child, etiology, treatment 

Cite and Share

AYŞE AKCAN ARIKAN,AGOP CITAK. Pediatric Shock. Signa Vitae. 2008. 3(1);13-23.


1. Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO estimates of the causes of death in children. Lancet 2005;365(9465):1147-52.

2. Hotchkiss RS, Swanson PE, Cobb JP, Jacobson A, Buchman TG, Karl IE. Apoptosis in lymphoid and parenchymal cells during sepsis: findings in normal and T- and B-cell-deficient mice. Crit Care Med 1997;25(8):1298-307.

3. Hotchkiss RS, Swanson PE, Freeman BD, Tinsley KW, Cobb JP, Matuschak GM, et al. Apoptotic cell death in patients with sepsis, shock, and multiple organ dysfunction. Crit Care Med 1999;27(7):1230-51.

4. Han YY, Carcillo JA, Dragotta MA, Bills DM, Watson RS, Westerman ME, et al. Early reversal of pediatric-neonatal septic shock by com-munity physicians is associated with improved outcome. Pediatrics 2003;112(4):793-9.

5. Parr GV, Blackstone EH, Kirklin JW. Cardiac performance and mortality early after intracardiac surgery in infants and young children. Circulation 1975;51(5):867-74.

6. Kirklin JK, Blackstone EH, Kirklin JW, McKay R, Pacifico AD, Bargeron LM, Jr. Intracardiac surgery in infants under age 3 months: predictors of postoperative in-hospital cardiac death. Am J Cardiol 1981;48(3):507-12.

7. Ceneviva G, Paschall JA, Maffei F, Carcillo JA. Hemodynamic support in fluid-refractory pediatric septic shock. Pediatrics 1998;102(2): e19.

8. Feltes TF, Pignatelli R, Kleinert S, Mariscalco MM. Quantitated left ventricular systolic mechanics in children with septic shock utilizing noninvasive wall-stress analysis. Crit Care Med 1994;22(10):1647-58.

9. Lambert HJ, Baylis PH, Coulthard MG. Central-peripheral temperature difference, blood pressure, and arginine vasopressin in preterm neonates undergoing volume expansion. Arch Dis Child Fetal Neonatal Ed 1998;78(1):F43-5.

10. McKiernan CA, Lieberman SA. Circulatory shock in children: an overview. Pediatr Rev 2005;26(12):451-60.

11. Watson RS, Carcillo JA, Linde-Zwirble WT, Clermont G, Lidicker J, Angus DC. The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med 2003;167(5):695-701.

12. Brilli RJ, Goldstein B. Pediatric sepsis definitions: past, present, and future. Pediatr Crit Care Med 2005;6(3 Suppl):S6-8.

13. Groeneveld AB, Bronsveld W, Thijs LG. Hemodynamic determinants of mortality in human septic shock. Surgery 1986;99(2):140-53.

14. Groeneveld AB, Nauta JJ, Thijs LG. Peripheral vascular resistance in septic shock: its relation to outcome. Intensive Care Med 1988;14(2):141-7.

15. Carcillo JA, Pollack MM, Ruttimann UE, Fields AI. Sequential physiologic interactions in pediatric cardiogenic and septic shock. Crit Care Med 1989;17(1):12-6.

16. Hayes MA, Timmins AC, Yau EH, Palazzo M, Watson D, Hinds CJ. Oxygen transport patterns in patients with sepsis syndrome or septic shock: influence of treatment and relationship to outcome. Crit Care Med 1997;25(6):926-36.

17. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345(19):1368-77.

18. Xia ZF, He F, Barrow RE, Broemeling LD, Herndon DN. Reperfusion injury in burned rats after delayed fluid resuscitation. J Burn Care Rehabil 1991;12(5):430-6.

19. Carcillo JA, Fields AI. Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 2002;30(6):1365-78.

20. Lipiner-Friedman D, Sprung CL, Laterre PF, Weiss Y, Goodman SV, Vogeser M, et al. Adrenal function in sepsis: the retrospective Corticus cohort study. Crit Care Med 2007;35(4):1012-8.

21. Carcillo JA, Davis AL, Zaritsky A. Role of early fluid resuscitation in pediatric septic shock. Jama 1991;266(9):1242-5.

22. Ranjit S, Kissoon N, Jayakumar I. Aggressive management of dengue shock syndrome may decrease mortality rate: a suggested protocol. Pediatr Crit Care Med 2005;6(4):412-9.

23. Carcillo JA, Tasker RC. Fluid resuscitation of hypovolemic shock: acute medicine’s great triumph for children. Intensive Care Med 2006;32(7):958-61.

24. Human albumin administration in critically ill patients: systematic review of randomised controlled trials. Cochrane Injuries Group Albumin Reviewers. Bmj 1998;317(7153):235-40.

25. 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;350(22):2247-56.

26. Upadhyay M, Singhi S, Murlidharan J, Kaur N, Majumdar S. Randomized evaluation of fluid resuscitation with crystalloid (saline) and colloid (polymer from degraded gelatin in saline) in pediatric septic shock. Indian Pediatr 2005;42(3):223-31.

27. Schroth M, Plank C, Meissner U, Eberle KP, Weyand M, Cesnjevar R, et al. Hypertonic-hyperoncotic solutions improve cardiac function in children after open-heart surgery. Pediatrics 2006;118(1):e76-84.

28. Ngo NT, Cao XT, Kneen R, Wills B, Nguyen VM, Nguyen TQ, et al. Acute management of dengue shock syndrome: a randomized double-blind comparison of 4 intravenous fluid regimens in the first hour. Clin Infect Dis 2001;32(2):204-13.

29. Boluyt N, Bollen CW, Bos AP, Kok JH, Offringa M. Fluid resuscitation in neonatal and pediatric hypovolemic shock: a Dutch Pediatric Society evidence-based clinical practice guideline. Intensive Care Med 2006;32(7):995-1003.

30. Goldstein SL, Currier H, Graf C, Cosio CC, Brewer ED, Sachdeva R. Outcome in children receiving continuous venovenous hemofiltration. Pediatrics 2001;107(6):1309-12.

31. Mortimer DS, Jancik J. Administering hypertonic saline to patients with severe traumatic brain injury. J Neurosci Nurs 2006;38(3):142-6.

32. Cooper DJ, Myles PS, McDermott FT, Murray LJ, Laidlaw J, Cooper G, et al. Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. Jama 2004;291(11):1350-7.

33. Choi PT, Yip G, Quinonez LG, Cook DJ. Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med 1999;27(1):200-10.

34. Alderson P, Bunn F, Lefebvre C, Li WP, Li L, Roberts I, et al. Human albumin solution for resuscitation and volume expansion in critically ill patients. Cochrane Database Syst Rev 2004(4):CD001208.

35. Booy R, Habibi P, Nadel S, de Munter C, Britto J, Morrison A, et al. Reduction in case fatality rate from meningococcal disease associated with improved healthcare delivery. Arch Dis Child 2001;85(5):386-90.

36. Perkin RM, Levin DL, Webb R, Aquino A, Reedy J. Dobutamine: a hemodynamic evaluation in children with shock. J Pediatr 1982;100(6):977-83.

37. De Backer D, Creteur J, Dubois MJ, Sakr Y, Koch M, Verdant C, et al. The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects. Crit Care Med 2006;34(2):403-8.

38. Ruokonen E, Parviainen I, Uusaro A. Treatment of impaired perfusion in septic shock. Ann Med 2002;34(7-8):590-7.

39. Lodha R, Vivekanandhan S, Sarthi M, Kabra SK. Serial circulating vasopressin levels in children with septic shock. Pediatr Crit Care Med 2006;7(3):220-4.

40. Masutani S, Senzaki H, Ishido H, Taketazu M, Matsunaga T, Kobayashi T, et al. Vasopressin in the treatment of vasodilatory shock in children. Pediatr Int 2005;47(2):132-6.

41. Lechner E, Hofer A, Mair R, Moosbauer W, Sames-Dolzer E, Tulzer G. Arginine-vasopressin in neonates with vasodilatory shock after cardiopulmonary bypass. Eur J Pediatr 2007;166(12):1221-7.

42. Rodriguez-Nunez A, Lopez-Herce J, Gil-Anton J, Hernandez A, Rey C. Rescue treatment with terlipressin in children with refractory septic shock: a clinical study. Crit Care 2006;10(1):R20.

43. Vallet B, Chopin C, Curtis SE, Dupuis BA, Fourrier F, Mehdaoui H, et al. Prognostic value of the dobutamine test in patients with sepsis syndrome and normal lactate values: a prospective, multicenter study. Crit Care Med 1993;21(12):1868-75.

44. Barton P, Garcia J, Kouatli A, Kitchen L, Zorka A, Lindsay C, et al. Hemodynamic effects of i.v. milrinone lactate in pediatric patients with septic shock. A prospective, double-blinded, randomized, placebo-controlled, interventional study. Chest 1996;109(5):1302-12.

45. Kumar A, Parrillo JE. Cytokines and septic myocardial depression: nitric oxide versus sphingosine/ceramide? Crit Care Med 1999;27(7):1391-3.

46. Reynolds EM, Ryan DP, Sheridan RL, Doody DP. Left ventricular failure complicating severe pediatric burn injuries. J Pediatr Surg 1995;30(2):264-9; discussion 269-70.

47. Beca J, Butt W. Extracorporeal membrane oxygenation for refractory septic shock in children. Pediatrics 1994;93(5):726-9.

48. Honore PM, Jamez J, Wauthier M, Lee PA, Dugernier T, Pirenne B, et al. Prospective evaluation of short-term, high-volume isovolemic hemofiltration on the hemodynamic course and outcome in patients with intractable circulatory failure resulting from septic shock. Crit Care Med 2000;28(11):3581-7.

49. Busund R, Koukline V, Utrobin U, Nedashkovsky E. Plasmapheresis in severe sepsis and septic shock: a prospective, randomised, control-led trial. Intensive Care Med 2002;28(10):1434-9.

50. Nguyen TC, Carcillo JA. Bench-to-bedside review: thrombocytopenia-associated multiple organ failure-a newly appreciated syndrome in the critically ill. Crit Care 2006;10(6):235.

51. Englehart MS, Schreiber MA. Measurement of acid-base resuscitation endpoints: lactate, base deficit, bicarbonate or what? Curr Opin Crit Care 2006;12(6):569-74.

52. Rixen D, Siegel JH. Bench-to-bedside review: oxygen debt and its metabolic correlates as quantifiers of the severity of hemorrhagic and post-traumatic shock. Crit Care 2005;9(5):441-53.

53. Dugas MA, Proulx F, de Jaeger A, Lacroix J, Lambert M. Markers of tissue hypoperfusion in pediatric septic shock. Intensive Care Med 2000;26(1):75-83.

54. Carcillo JA. What’s new in pediatric intensive care. Crit Care Med 2006;34(9 Suppl):S183-90.

55. Nguyen HB, Corbett SW, Steele R, Banta J, Clark RT, Hayes SR, et al. Implementation of a bundle of quality indicators for the early man-agement of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med 2007;35(4):1105-12.

56. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med 2004;30(4):536-55.

57. Cartwright K, Reilly S, White D, Stuart J. Early treatment with parenteral penicillin in meningococcal disease. Bmj 1992;305(6846):143-7.

58. Strang JR, Pugh EJ. Meningococcal infections: reducing the case fatality rate by giving penicillin before admission to hospital. Bmj 1992;305(6846):141-3.

59. Casartelli CH, Garcia PC, Branco RG, Piva JP, Einloft PR, Tasker RC. Adrenal response in children with septic shock. Intensive Care Med 2007;33(9):1609-13.

60. Oppert M, Schindler R, Husung C, Offermann K, Graf KJ, Boenisch O, et al. Low-dose hydrocortisone improves shock reversal and reduces cytokine levels in early hyperdynamic septic shock. Crit Care Med 2005;33(11):2457-64.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time