Septic shock (pediatry): Difference between revisions

Revision as of 14:44, 3 January 2023

Septic shock is usually a combination of pathophysiological conditions. Hypovolaemia, myocardial depression with predominant influence of distribution disorders participate in septic shock. In the initial stages, in terms of circulatory parameters, it is described as a hyperdynamic state with high minute cardiac output and reduced systemic vascular resistance. The same hemodynamic picture is found in hepatic failure, hyperthyroidism and traumatic shock without significant hypovolaemia. In septic shock, peripheral perfusion is abnormal. Initially, children are well perfused, have dilated pulse pressure, PulP (difference between sTK and dTK) and increased CI. However, the increase in CO/CI usually does not compensate for the significant decrease in SVRI, hence systemic hypotension occurs. In addition, with time, myocardial function is also affected (decreased pulse volume and decreased ejection fraction) and CI is decreased. In the textbook case, the further evolution of the septic state tends towards an escalation of peripheral vascular resistance and a low flow picture. In the final stage, myocardial function is affected, the picture approaches the symptomatology of cardiogenic shock and MODS develops.

References

Sources

HAVRÁNEK, Jiří: Šok. (edited)

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-'''Septický šok''' je zpravidla kombinací patofyziologických stavů. Na septickém [[šok]]u participuje hypovolémie, deprese myokardu s převládajícím vlivem distribuční poruchy. V iniciálních fázích z hlediska cirkulačních parametrů je popisován jako '''hyperdynamický''' stav s vysokým minutovým srdečním výdejem a sníženou systémovou vaskulární rezistencí. Stejný hemodynamický obraz nacházíme u [[jaterní selhání|jaterního selhání]], [[hyperthyreóza|hyperthyreoidismu]] a traumatického šoku bez významné hypovolémie. U septického šoku je abnormální situace v oblasti '''periferní perfúze'''. Zpočátku jsou děti dobře prokrvené, mají rozšířený pulse pressure, PulP (rozdíl mezi sTK a dTK) a zvýšený CI. Nicméně zvýšení CO/CI zpravidla nekompenzuje významný pokles SVRI, tudíž dochází k systémové hypotenzi. S postupem času je navíc postižena i funkce myokardu (snížení tepového objemu a snížení ejekční frakce) a dochází k poklesu CI. V učebnicovém případě další vývoj septického stavu směřuje k vystupňování periferní vaskulární rezistence a k obrazu low flow. V konečné fázi dochází k postižení funkce myokardu, obraz se blíží symptomatologii [[kardiogenní šok (pediatrie)|šoku kardiogenního]] a k rozvoji [[Syndrom multiorgánové dysfunkce|MODS]].
 '''Septic shock''' is usually a combination of pathophysiological conditions. Hypovolaemia, myocardial depression with predominant influence of distribution disorders participate in [[septic]] shock. In the initial stages, in terms of circulatory parameters, it is described as a '''hyperdynamic''' state with high minute cardiac output and reduced systemic vascular resistance. The same hemodynamic picture is found in [[hepatic failure]], [[hyperthyroidism]] and traumatic shock without significant hypovolaemia. In septic shock, '''peripheral perfusion''' is abnormal. Initially, children are well perfused, have dilated pulse pressure, PulP (difference between sTK and dTK) and increased CI. However, the increase in CO/CI usually does not compensate for the significant decrease in SVRI, hence systemic hypotension occurs. In addition, with time, myocardial function is also affected (decreased pulse volume and decreased ejection fraction) and CI is decreased. In the textbook case, the further evolution of the septic state tends towards an escalation of peripheral vascular resistance and a low flow picture. In the final stage, myocardial function is affected, the picture approaches the symptomatology of [[cardiogenic shock]] and [[MODS]] develops.
-{{Podrobnosti|Sepse u novorozence}}<noinclude>
 ==References==
 ===Sources===
-*HAVRÁNEK, Jiří: ''Šok''. (upraveno)
+*HAVRÁNEK, Jiří: ''Šok''. (edited)
 ===Related articles===
 *[[Shock classification (pediatry)]]
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 *[[Sepsis]]
 *[[Neonatal sepsis]]
-</noinclude>[[Category:Inserted articles]] [[Category:Pediatry]] [[Category:Internal medicine]] [[Category:Cardiology]] [[Category:Phisiology]] [[Category:Patophysiology]]
+</noinclude>
+[[Category:Inserted articles]] [[Category:Pediatry]] [[Category:Internal medicine]] [[Category:Cardiology]] [[Category:Phisiology]] [[Category:Patophysiology]]