The Pediatric Patient Cared for in the Adult ICU
There are many similarities between the physiology of pediatric and adult shock, including the types of circulatory shock: hypovolemic, cardiogenic, obstructive, and distributive (Table 37.1). Pediatric patients, however, may demonstrate more subtle manifestations of the shock state, leading to potential for delayed recognition. Additionally, the response to states of altered ventricular preload, cardiac contractility, and vascular resistance is different in pediatric patients than adults. Cardiac output (CO) is more heavily dependent on heart rate (HR) than stroke volume (SV) in the young pediatric population as ventricular myocyte mass is still developing. Additionally, children are able to mount a significant and lasting increase in systemic vascular resistance (Fig. 37.1). Therefore, in contrast to adults, pediatric patients in states of shock may manifest tachycardia without hypotension (McKiernan 2005). It is critical to recognize shock state before the development of hypotension. Upon recognition of shock, volume resuscitation, inotropic support, and vasoactive therapy must be rapidly implemented. Early consideration of adjunctive support measures such as extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP), and ventricular assist devices (VADs) may improve outcomes for pediatric patients in refractory shock (ECLS 2013).
KeywordsPediatric resuscitation Pediatric shock Adult congenital malformations Intraosseous line Cystic fibrosis
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