Management of Shock in Infants and Children

The definition of shock has seen multiple iterations in the past several decades. In its most recent form, shock is understood to comprise a series of insults to the body resulting in impaired end-organ perfusion and generalized tissue underoxygenation. Causative factors are protean, although a large proportion of recent attention has been placed on infectious etiologies, particularly those in the compromised host. Diagnosis and treatment of pediatric shock are particularly challenging because of inherent difficulties in examining a young patient, early compensation of advanced shock, and, in some cases, a lack of provider familiarity with early signs and symptoms of impaired perfusion. Perhaps the most important advance in the past several years has been the recognition that shock must be identified early and sometimes treated empirically, without a proven etiology. In addition, systems of practice are essential to focus early, aggressive treatment of shock and prevent associated morbidity and mortality. In this review, we discuss key points to the evaluation of a pediatric patient with suspected shock, define what laboratory and radiologic investigations may be of utility in conf