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Schock im Kindesalter – viele Ursachen und schwierig zu erkennen

Definition und Besonderheiten im Kindesalter

Shock in childhood—many causes and difficult to recognize

Definition and characteristics in childhood

  • Leitthema
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Monatsschrift Kinderheilkunde Aims and scope Submit manuscript

Zusammenfassung

Der Schock wird im Kindesalter in seiner Schwere und seinem zeitlichen Verlauf häufig unterschätzt. Er stellt einen bedrohlichen Zustand dar, bei dem aufgrund des Kreislaufversagens der Sauerstoffbedarf wichtiger Organe nicht mehr gedeckt werden kann. Dies geht bei inadäquater oder spät eingeleiteter Therapie – insbesondere im Fall von Kindern – mit einer hohen Letalität einher; sekundäre Organschäden bis zum Multiorganversagen können resultieren. Die verlängerte Kapillarfüllungszeit (CRT) ist ein sehr spezifisches und frühes Zeichen der Zentralisation, während die Blutdruckwerte im Kindesalter trotz schweren Schocks durch Erhöhung des peripheren Widerstands lange noch normal sein können. Nach seiner Ursache wird der Schock in hypovolämisch, distributiv, kardiogen und obstruktiv eingeteilt. Er muss zügig behandelt werden; hierbei erfordern die einzelnen Schockformen jeweils eine differenzierte Therapie. Bei unklarer Ätiologie bestehen die initialen Maßnahmen aus Volumen- und Katecholamingaben.

Abstract

The severity and temporal course of shock are often underestimated in childhood. It represents a threatening situation in which the oxygen needs of important organs cannot be covered due to the circulatory collapse. In cases of inadequate or delayed initiation of treatment it is associated with a high mortality, especially in children; this can result in secondary organ damage up to multiorgan failure. The lengthened capillary refill time (CRT) is a very specific and early sign of centralization, whereas the blood pressure values in childhood can remain normal for a long time despite severe shock through an increase of the peripheral resistance. Shock is classified into hypovolemic, distributive, cardiogenic and obstructive shock, according to the underlying mechanism. It has to be treated promptly whereby the individual forms of shock each need a differentiated treatment. When the etiology is unclear the initial treatment measures are fluid resuscitation and administration of catecholamine.

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Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Kinderkardiologie, Uniklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland

    M. Emmel

  2. Abteilung Pädiatrische Intensivmedizin, Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität, München, Deutschland

    F. Hoffmann

  3. Abteilung Pädiatrische Intensivmedizin, Kinderheilkunde I, Universitätsmedizin Essen, Essen, Deutschland

    C. Dohna-Schwake

  4. Klinik für Anästhesie, Operative Intensiv- und Palliativmedizin, Städtisches Klinikum Solingen gGmbH, Solingen, Deutschland

    T. Standl

  5. Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Köln, Deutschland

    C. Menzel

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Correspondence to M. Emmel.

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Interessenkonflikt

M. Emmel, F. Hoffmann, C. Dohna-Schwake, T. Standl und C. Menzel geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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F. Hoffmann, München

F. Zepp, Mainz

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Emmel, M., Hoffmann, F., Dohna-Schwake, C. et al. Schock im Kindesalter – viele Ursachen und schwierig zu erkennen. Monatsschr Kinderheilkd 168, 118–129 (2020). https://doi.org/10.1007/s00112-019-00835-5

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