Vijayamohan, V K (2011) Clinical profile of shock in children in a Tertiary Care Hospital, Madurai. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Shock or circulatory failure is an acute syndrome characterized by inadequate circulatory perfusion of tissues to meet the metabolic demands of vital organs. Shock is one of the commonest pediatric emergencies. The shock states in children are classified according to the etiological factors namely hypovolemic shock due to volume depletion, cardiogenic shock due to cardiac dysfunction, distributive shock due to abnormal vasodilatation and septic shock due to increased vascular permeability. Early recognition with efficient, anticipatory, and aggressive management of children in shock is mandatory and will often be rewarding, as early restoration of tissue perfusion to normalcy will determine the immediate outcome. The final outcome will depend upon the nature of etiology and the availability of intervention measures. These children with shock are often referred to tertiary care facility for admission and management. The time lapse between the onset of this state and the time of admission and initiation of resuscitative measures is a great factor in determining the outcome. These children are looked after in a pediatric intensive care setup where constant observation and vigil with appropriate monitoring of various clinical parameters and laboratory parameters will determine and modify the therapeutic intervention which in turn will determine the outcome. AIM OF THE STUDY: 1. To find out the incidence of shock states in pediatric age group in Govt. Rajaji Hospital, Madurai. 2. To categorize the shock states based on etiology. 3. To find out association of various clinical and monitoring paramerters of shock with outcome. DISCUSSION: Shock is one of the most common emergencies in pediatrics. In our study it is accounted for 81 /7095 admissions in Pediatric ward. In a study done by Daljit Singh et al it accounted for 4.5% of PICU admissions. In our study most common age group was less than one year (accounting for 34.56%) followed by 1-5years (33.33%). In our study male patients constituted about 49.38% and female patients 50.61%. This is not in accordance to study by Praveen Khilani et al in which males constituted 60%, which was mainly due to male dominated society in India. In this study the overall mortality in shock was 41.97% (34/81) which is in concordance with that found in the literature (30-60%).1,39 In a study done by Daljith Singh et al mortality was 26.4%.63 There was no significant influence of sex on the out come in present study. Similar findings have been observed in Daljit Singh et al study. 63 But ,children less than 1 year showed higher mortality rate and children 6-10 years showed higher survival rate. De Freitas and Aragao et al found out that in children admitted to ICU mortality was higher in children less than 2 years of age.65 And in a study by Chang P et al on non-traumatic shock cases, age less than 2 years tend to have poor outcome. 39 In a study done by Kumar et al, on triage scoring of severity of illness in SIRS children, the mortality increased with decreasing age. In this study, Hypovolemic shock is the most common cause of shock 34/81(41.97%) followed by septic shock 22/81(27.16%), Dengue shock 17/81(20.98%) and cardiogenic shock 8/81(9.8%). CONCLUSION: 1. A total of 81 cases who met the definition of shock among 7095 patients admitted to the ward during the study period which constituted 1.14% admissions. 2. Majority of cases are in the age group of < 1 year (34.16%). 3. There was no significant difference in the sex distribution in the survivors and non-survivors, while children among 6-10 years showed higher survival rate. 4. Out of 81 cases of shock in this study, hypovolemic shock(41.97%) was the most common cause of shock followed septic(27.16%) ,Dengue(20.98%) and cardiogenic shock(9.8%). The most common infection of septic shock were pneumonia and neuroinfection. The most common cause of cardiogenic shock were myocarditis and congenital heart disease and for hypovolemic shock was gastroenteritis. 5. In this study overall mortality of shock was 41.97%. Septic shock has got highest mortality (68.18%) and hypovolemic shock has got least mortality (20.58%). 6. Temporal patterns of various clinical parameters showed a trend towards normalization of the various physiological variables in survivors in the first 24-48 hours where as the variables tend to be abnormal in non-survivors. 7. The clinical variables at admission which were significantly different between survivors and non survivors were: • GCS (mean±SD) – survivors (13.02±1.99), non-survivors (7.85±2.73), p value <0.001. • Heart rate (mean±SD) – survivors (133.17±23.25), non-survivors (156.23±34.02), p<0.001. There was increased need of mechanical ventilator in non-survivors (85.29%) as compared to survivors (6.3%), (p=0.001). Septic shock has got highest mortality (65.5%) followed by cardiogenic shock (31.0%) and hypovolemic shock has got least mortality (3.4%). The clinical variables at 24 hrs after admission, which were significantly different between survivors and non-survivors, were heart rate. Mean arterial blood pressure, capillary refilling time, core and peripheral temperature gradient and urine out put.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Linical Profile ; Shock ; Children ; Tertiary Care Hospital ; Madurai |
| Subjects: | MEDICAL > Paediatrics |
| Depositing User: | Ravindran C |
| Date Deposited: | 17 Apr 2018 11:36 |
| Last Modified: | 10 Jun 2018 12:20 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7057 |
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