Study of Clinical Profile and outcome of Shock in Pediatric Intensive Care Unit of a Tertiary Referral Hospital

Rangasamy, K (2007) Study of Clinical Profile and outcome of Shock in Pediatric Intensive Care Unit of a Tertiary Referral Hospital. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Shock occurs in approximately 2% of all hospitalized children and adults in the united states 1. Majority of the childhood illness have the potential to lead to shock. Shock accounts for more morbidity and mortality in children world wide than any other diagnosis.2,3 Shock is one of the most dramatic, dynamic and life-threatening problems faced by the physician in critical care setting4. High index of suspicion is needed for early identification of shock. Early institution of treatment will definitely reduce the chances of progression of shock to end up in cardio respiratory failure. Rapid and focused cardiopulmonary assessment adds in the early recognition of shock state.5 Many studies have been done to classify shock at presentation and emphasize that there exists a wide range of etiologies for shock. The mortality rate of shock in pediatric patients has declined as a consequence of educational efforts (pediatric advance life support), which emphasize early recognition and intervention and rapid transfer of critically ill patients to a PICU via a transport service. AIM OF THE STUDY: To find the following in the paediatric intensive care unit: 1. Etiology and type of shock 2. Outcome of shock 3. Risk factors for mortality of shock in children admitted in PICU. DISCUSSION: In present study the frequency of shock was found to be 1.63%. According to Western data, shock occurs in approximately 2% of all hospitalized children and adults in united states1. In a study conducted by Daljit singh et al10 they found frequency of shock was 4.3%. The present study showed that maximum patients were observed in infancy, as is also reported by Daljit singh et al10. In our study, we found that fever was the common presentation in all age group followed by refusal of feeds in infant, breathlessness in other age groups. In our study fever was the common presentation in septic and hypovolemic shock.. Breathlessness was the common presentation in cardiogenic shock, in our study it was uniformly presenting all cases of cardiogenic shock convulsions were the most common presentation in distributive shock. In our study, we found that septic shock was the most common type of shock (47.4%), followed by distributive shock (19.5%), hypovolemic shock (17.4%), and cardiogenic shock (15.7%), This is contrary to the previous studies, where they found hypovolemic shock due to diarrhoea was the commonest cause of shock in children. This is because in our hospital children presenting with diarrhoea and shock, after the initial fluid resuscitation in the emergency room, will be admitted in separate diarrhoea ward, unless they have associated complications. As the present study is confined to children who present with shock to the PICU, the causes will be mostly diseases other than acute watery diarrhoea. A few cases of diarrhoea may get admitted in PICU, if they develop some complications. The incidence of septic shock is increasing world over with a 10 fold increase in the past 20 years, the reason being that more patients are surviving with the disease which were fatal previously and due to increase in invasive procedures which constitute risk factors for developing sepsis10. In our study culture proven sepsis were found in 36 cases (32.1%), and most of them were Gram negative organisms, which is similar to the previous studies1,15,16,17 . The other culture negative septic shock can be explained as majority of patients had received intravenous antibiotics as out patients before being referred to our hospital. Jacobs RF et al 15 in their study of septic shock in children found an incidence 25.2% of culture proven sepsis, of which H.Influenzae B, N.meningitidis and S.pneumoniae were the predominant organisms. In our study we found that infections were the common cause of shock in younger age group. DKA and status eplepticus/ seizure disorder were the common causes of shock in older age groups. SUMMARY AND CONCLUSION: 1. Shock is a common presentation of a critically ill child contributing about 1.63% of hospital admissions. 2. The etiology of shock varies with age groups with incidence decreasing as age advances. 3. Bronchopneumonia and other infections are the most common cause of shock in infants and younger children. 4. Seizure disorder / status epilepticus and diabetic keto acidosis are the common causes of shock in older children. 5. Septic shock is the most common type of shock in children admitted in PICU. 6. Under nutrition, Decompensated shock, inotrope requirement, MODS, leucopenia and ventilatory support are independently associated with poor outcome. 7. Diagnosis and management of shock in early compensated stage carries better prognosis than in decompensated shock irrespective of the age of the patient

Item Type: Thesis (Masters)
Uncontrolled Keywords: Study ; Clinical Profile ; Shock ; Pediatric Intensive Care Unit ; Tertiary Referral Hospital
Subjects: MEDICAL > Paediatrics
Depositing User: Ravindran C
Date Deposited: 23 Apr 2018 05:38
Last Modified: 23 Apr 2018 05:38

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