Chapter-25 Septic Shock

BOOK TITLE: Recent Advances in Pediatrics (Volume 20: Hot Topics)

1. Babu T Arun
2. Venkatesh C
Publishing Year
Author Affiliations
1. Sri Lakshmi Narayana Institute of Medical Sciences, Pondicherry, India, Indira Gandhi Medical College and Research Institute (IGMCRI), Puducherry, India
2. SL Institute of Medical Sciences, Pondicherry, India, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondichery, India
Chapter keywords


Septic shock is a leading cause of mortality in children, especially in the developing world and in the intensive care settings. Majority of these patients are neonates; the morbidity and mortality is far high in low birthweight infants. Constant advances are being made in the management of septic shock in the wake of the changing epidemiology and available evidence. Endothelial dysfunction and disrupted microvasculature due to discordance between pro-inflammatory and anti-inflammatory cytokines play a key role in the pathogenesis of septic shock. Early recognition, appropriate antibiotic therapy, volume resuscitation and mechanical ventilation improve outcome in pediatric septic shock. There is no difference in survival between using crystalloids or colloids in fluid resuscitation. Hydrocortisone therapy should be reserved for use in children with catecholamine resistance and suspected or proven adrenal insufficiency. Activated protein C currently not recommended due to increased risk of central nervous system bleeding. Numerous novel treatment modalities for septic shock in children are being studied in the hope that some of these may turn out to be clinically beneficial in the near future.

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