Noninvasive hemodynamic monitoring of septic shock in children

作     者：Emad Mohamed Fathi Hassib Narchi Fares Chedid 

作者机构：Department of Critical CareAl Jalila Children’s Specialty Hospital Department of PediatricsCollege of Medicine and Health SciencesUnited Arab Emirates University Neonatal Intensive Care UnitOasis Hospital 

出 版 物：《World Journal of Methodology》 (世界方法学杂志)

年 卷 期：2018年第8卷第1期

页      面：1-8页

学科分类：10[医学] 

主　　题：Hemodynamics Monitoring Septic shock Pediatric Trans-esophageal Doppler Echocardiography Cardiometry Near infrared spectroscopy Trans-thoracic Doppler 

摘      要：Septic shock in children is associated with high mortality and morbidity. Its management is time-sensitive and must be aggressive and target oriented. The use of clinical assessment alone to differentiate between cold and warm shock and to select the appropriate inotropic and vasoactive medications is fraught with errors. Semiquantitative and quantitative assessment of the preload,contractility and afterload using non-invasive tools has been suggested,in conjunction with clinical and laboratory assessment,to direct shock management and select between vasopressors,vasodilators and inotropes or a combination of these drugs. This review aims to describe non-invasive tools to assess the hemodynamic status in septic shock including echocardiography,trans-thoracic/trans-esophageal Doppler and electrical cardiometry. As septic shock is a dynamic condition that changes markedly overtime,frequent or continuous measurement of the cardiac output(CO),systemic vascular resistance(SVR) and other hemodynamic parameters using the above-mentioned tools is essential to personalize the treatment and adapt it over time. The different combinations of blood pressure,CO and SVR serve as a pathophysiological framework to manage fl-uid therapy and titrate inotropic and vasoactive drugs. Near infrared spectroscopy is introduced as a noninvasive method to measure end organ perfusion and assess the response to treatment.