Skip to main content

Circulatory Failure/Shock

  • Chapter
  • First Online:
Pediatric Critical Care Study Guide
  • 3689 Accesses

Abstract

Shock is a common manifestation of many forms of critical illness. Although a patient with hypotension can have shock, shock is not necessarily defined by hypotension. That is, a patient can have a “normal” blood pressure and have shock concurrently. Accordingly, the definition of shock is based upon the concepts of oxygen delivery, the circulation-related factors that govern oxygen delivery, and tissue oxygen requirements. When tissue oxygen requirements are not met by the circulatory system, be it due to poor myocardial function, hypovolemia, and/or hypotension, a patient is said to be in shock.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Suggested Readings

  • Abraham E, Reinhart K, Opal S, Demeyer I, Doig C, Rodriguez AL, et al. Efficacy and safety of tifacogin (recombinant tissue factor pathway inhibitor) in severe sepsis: a randomized controlled trial. JAMA. 2003;290:238–47.

    Article  PubMed  CAS  Google Scholar 

  • Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288:862–71.

    Article  PubMed  CAS  Google Scholar 

  • Barton P, Kalil AC, Nadel S, Goldstein B, Okhuysen-Cawley R, Brilli RJ, et al. Safety, pharmacokinetics, and pharmacodynamics of drotrecogin alfa (activated) in children with severe sepsis. Pediatrics. 2004;113:7–17.

    Article  PubMed  Google Scholar 

  • Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001; 344:699–709.

    Article  PubMed  CAS  Google Scholar 

  • Brierley J, Carcillo JA, Choong K, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009;37(2):666–88.

    Article  PubMed  Google Scholar 

  • Carcillo JA, Davis AL, Zaritsky A. Role of early fluid resuscitation in pediatric septic shock. JAMA. 1991;266:1242–5.

    Article  PubMed  CAS  Google Scholar 

  • Ceneviva G, Paschall JA, Maffei F, Carcillo JA. Hemodynamic support in fluid-refractory pediatric septic shock. Pediatrics. 1998;102:e19.

    Article  PubMed  CAS  Google Scholar 

  • Cornell TT, Wynn J, Shanley TP, Wheeler DS, Wong HR. Mechanisms and regulation of the gene-expression response to sepsis. Pediatrics. 2010;125(6):1248–58.

    Article  PubMed  Google Scholar 

  • Cuzzocrea S. Shock, inflammation and PARP. Pharmacol Res. 2005;52(1):72–82.

    Article  PubMed  CAS  Google Scholar 

  • de Oliveira CF, de Oliveira DS, Gottschald AF, Moura JD, Costa GA, Ventura AC, et al. ACCM/PALS haemodynamic support guidelines for paediatric septic shock: an outcomes comparison with and without monitoring central venous oxygen saturation. Intensive Care Med. 2008;34(6):1065–75.

    Article  PubMed  Google Scholar 

  • Dellinger RP, Levy MM, Carlet JM, Surviving Sepsis Campaign, et al. International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36:296–327.

    Article  PubMed  Google Scholar 

  • Ding J, Song D, Ye X, Liu SF. A pivotal role of endothelial-specific NF-kappaB signaling in the pathogenesis of septic shock and septic vascular dysfunction. J Immunol. 2009;183(6):4031–8.

    Article  PubMed  CAS  Google Scholar 

  • Fernandes Jr CJ, Akamine N, Knobel E. Myocardial depression in sepsis. Shock. 2008;30 Suppl 1:14–7.

    Article  PubMed  CAS  Google Scholar 

  • Fernandes D, Assreuy J. Nitric oxide and vascular reactivity in sepsis. Shock. 2008;30 Suppl 1:10–3.

    Article  PubMed  CAS  Google Scholar 

  • Fortin CF, McDonald PP, Fülöp T, Lesur O. Sepsis, leukocytes, and nitric oxide (NO): an intricate affair. Shock. 2010;33(4):344–52.

    Article  PubMed  CAS  Google Scholar 

  • Hotchkiss RS, Tinsley KW, Karl IE. Role of apoptotic cell death in sepsis. Scand J Infect Dis. 2003;35:585–92.

    Article  PubMed  CAS  Google Scholar 

  • Iwasaki A, Medzhitov R. Toll-like receptor control of the adaptive immune responses. Nat Immunol. 2004;5:987–95.

    Article  PubMed  CAS  Google Scholar 

  • Jean-Baptiste E. Cellular mechanisms in sepsis. J Intensive Care Med. 2007;22(2):63–72.

    Article  PubMed  Google Scholar 

  • Kilbourn RG, Szabo C, Traber DL. Beneficial versus detrimental effects of nitric oxide synthase inhibitors in circulatory shock: lessons learned from experimental and clinical studies. Shock. 1997;7:235–46.

    Article  PubMed  CAS  Google Scholar 

  • Kumar A, Kumar A, Paladugu B, Mensing J, Parrillo JE. Transforming growth factor-beta1 blocks in vitro cardiac myocyte depression induced by tumor necrosis factor-alpha, interleukin-1beta, and human septic shock serum. Crit Care Med. 2007;35(2): 358–64.

    Article  PubMed  CAS  Google Scholar 

  • Lapinsky SE, Richards GA. Pro/con clinical debate: pulmonary artery catheters increase the morbidity and mortality of intensive care unit patients. Crit Care. 2003;7:101–3.

    Article  PubMed  Google Scholar 

  • Liu SF, Malik AB. NF-kappa B activation as a pathological mechanism of septic shock and inflammation. Am J Physiol Lung Cell Mol Physiol. 2006;290(4):L622–45.

    Article  PubMed  CAS  Google Scholar 

  • Malhotra V, Wong HR. Interactions between the heat shock response and the nuclear factor-kappa B signaling pathway. Crit Care Med. 2002;30:S89–95.

    Article  CAS  Google Scholar 

  • Pizarro CF, Troster EJ, Damiani D, Carcillo JA. Absolute and relative adrenal insufficiency in children with septic shock. Crit Care Med. 2005;33(4):855–9.

    Article  PubMed  CAS  Google Scholar 

  • Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–77.

    Article  PubMed  CAS  Google Scholar 

  • Roger T, Froidevaux C, Le Roy D, Reymond MK, Chanson AL, Mauri D, et al. Protection from lethal gram-negative bacterial sepsis by targeting Toll-like receptor 4. Proc Natl Acad Sci USA. 2009;106(7):2348–52.

    Article  PubMed  CAS  Google Scholar 

  • Schmidt C, Kurt B, Höcherl K, Bucher M. Inhibition of NF-kappaB activity prevents downregulation of alpha1-adrenergic receptors and circulatory failure during CLP-induced sepsis. Shock. 2009;32(3):239–46.

    Article  PubMed  CAS  Google Scholar 

  • Watson RS, Carcillo JA, Linde-Zwirble WT, Clermont G, Lidicker J, Angus DC. The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med. 2003;167:695–701.

    Article  PubMed  Google Scholar 

  • Wheeler DS, Fisher Jr LE, Catravas JD, Jacobs BR, Carcillo JA, Wong HR. Extracellular hsp70 levels in children with septic shock. Pediatr Crit Care Med. 2005;6(3):308–11.

    Article  PubMed  Google Scholar 

  • Wheeler DS, Lahni P, Odoms K, Jacobs BR, Carcillo JA, Doughty LA, et al. Extracellular heat shock protein 60 (Hsp60) levels in children with septic shock. Inflamm Res. 2007;56(5):216–9.

    Article  PubMed  CAS  Google Scholar 

  • Wong HR, Carcillo JA, Burckart G, Kaplan SS. Nitric oxide production in critically ill patients. Arch Dis Child. 1996;74:482–9.

    Article  PubMed  CAS  Google Scholar 

  • Wong HR, Cvijanovich N, Allen GL, Lin R, Anas N, Meyer K, et al. Genomic expression profiling across the pediatric systemic inflammatory response syndrome, sepsis, and septic shock spectrum. Crit Care Med. 2009;37(5):1558–66.

    Article  PubMed  CAS  Google Scholar 

  • Zacharowski K, Zacharowski PA, Koch A, Baban A, Tran N, Berkels R, et al. Toll-like receptor 4 plays a crucial role in the immune-adrenal response to systemic inflammatory response syndrome. Proc Natl Acad Sci USA. 2006;103(16):6392–7.

    Article  PubMed  CAS  Google Scholar 

  • Zingarelli B, Sheehan M, Wong HR. Nuclear factor-kappaB as a therapeutic target in critical care medicine. Crit Care Med. 2003;31:S105–11.

    Article  PubMed  CAS  Google Scholar 

  • Zinkernagel AS, Johnson RS, Nizet V. Hypoxia inducible factor (HIF) function in innate immunity and infection. J Mol Med. 2007;85(12):1339–46.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag London Limited

About this chapter

Cite this chapter

Wong, H.R. (2012). Circulatory Failure/Shock. In: Lucking, S., Maffei, F., Tamburro, R., Thomas, N. (eds) Pediatric Critical Care Study Guide. Springer, London. https://doi.org/10.1007/978-0-85729-923-9_26

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-923-9_26

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-922-2

  • Online ISBN: 978-0-85729-923-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics