SHOCK . .

Clinical parameters for hemodynamic support of pediatric and neonatal patients in septic shock

Critical Care Medicine, vol 30, number 6, June 2002

From the American College of Critical Care Medicine

SHOCK 4 196097%198060%1999 9%

SHOCK 9%27%

SHOCK C.O.

SHOCK ( C.I. 3.3 6 L/min/m2 ) ( Vo2 >200 ml/min/m2 )

SHOCK [ ]

( shock )

Q = dP/R

CO= MAP-CVP/SVR

2

SHOCK

Kanter RK , Zimmerman JJ , Strauss RH , et al: Pediatric emergency intravenous access : Evaluation of a protocol . Am J Dis Child 1986 ; 140 : 132134 Idris AH , Melker RS : High flow sheaths for pediatric fluid resuscitation : A comparison of flow rates with standard pediatric catheters . Pediatr Emerg Care 1992 ; 8 : 119122

Boluses 20 ml/kg ( : ) 40-60 ml/kg 200 ml/kg monitoringWegde Pressure 12-15 mm Hg

ARDS

MONITORING U/S Sat ( >70% ) shock dopamine MAP, CVP, SaO2AEcho pHi Femory artery Thermodilution

Dopamine shock epinephrine ( < 6 )Nor-epinephrine () shock

Angiotensin arginin vasopressin down regulation Methylene blue

DobutamineDopamine( < 12 x epinephrine)Epinephrine( () shock )Milrinone ( )Amrinone ( )( , shock, epinephrine )

shock ( )Milrinone amrinone( ) -

- Ca++ ( 21, )

shock 0-18 mg/dl , . Waterhouse-Friedrichson, ,

ECMO

E.C.M.O. (37-50% 80% ) ( shock)

Recommendations for stepwise management of hemodynamic support in infants and children with goals of normal perfusion and perfusion pressure (mean arterial pressure central venous pressure [MAP CVP]). Proceed to next step if shock persists. PALS, pediatric advanced life support; PICU, pediatric intensive care unit; SVC O2 , superior vena cava oxygen; PDE, phosphodiesterase; CI, cardiac index; ECMO, extracorporeal membrane oxygenation.

Recommendations for stepwise management of hemodynamic support in term newborns with goals of normal perfusion and perfusion pressure (mean arterial pressure central venous pressure) and preductal and postductal oxygen saturation difference of