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World J Methodol. Jun 28, 2018; 8(1): 1-8
Published online Jun 28, 2018. doi: 10.5662/wjm.v8.i1.1
Noninvasive hemodynamic monitoring of septic shock in children
Emad Mohamed Fathi, Hassib Narchi, Fares Chedid
Emad Mohamed Fathi, Department of Critical Care, Al Jalila Children’s Specialty Hospital, Dubai 7662, United Arab Emirates
Hassib Narchi, Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 17666, United Arab Emirates
Fares Chedid, Neonatal Intensive Care Unit, Oasis Hospital, Al Ain 1016, United Arab Emirates
Author contributions: All authors contributed equally to this paper.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Emad Mohamed Fathi, MSc, MRCPCH, EPIC, Department of Critical Care, Al Jalila Children’s Specialty Hospital, Al Jaddaf, Dubai 7662, United Arab Emirates. efmoustafa@ajch.ae
Telephone: +971-50-3127281
Received: March 3, 2018
Peer-review started: March 6, 2018
First decision: April 4, 2018
Revised: April 10, 2018
Accepted: May 11, 2018
Article in press: May 11, 2018
Published online: June 28, 2018
Processing time: 114 Days and 9.4 Hours
Abstract

Septic shock in children is associated with high mortality and morbidity. Its management is time-sensitive and must be aggressive and target oriented. The use of clinical assessment alone to differentiate between cold and warm shock and to select the appropriate inotropic and vasoactive medications is fraught with errors. Semi-quantitative and quantitative assessment of the preload, contractility and afterload using non-invasive tools has been suggested, in conjunction with clinical and laboratory assessment, to direct shock management and select between vasopressors, vasodilators and inotropes or a combination of these drugs. This review aims to describe non-invasive tools to assess the hemodynamic status in septic shock including echocardiography, trans-thoracic/trans-esophageal Doppler and electrical cardiometry. As septic shock is a dynamic condition that changes markedly overtime, frequent or continuous measurement of the cardiac output (CO), systemic vascular resistance (SVR) and other hemodynamic parameters using the above-mentioned tools is essential to personalize the treatment and adapt it over time. The different combinations of blood pressure, CO and SVR serve as a pathophysiological framework to manage fluid therapy and titrate inotropic and vasoactive drugs. Near infrared spectroscopy is introduced as a non-invasive method to measure end organ perfusion and assess the response to treatment.

Keywords: Hemodynamics; Monitoring; Septic shock; Pediatric; Trans-esophageal Doppler; Echocardiography; Cardiometry; Near infrared spectroscopy; Trans-thoracic Doppler

Core tip: We have reviewed noninvasive tools, such as echocardiography, Doppler and electrical cardiometry used to evaluate the hemodynamic status and response to treatment of children with septic shock. As septic shock is a dynamic condition that changes markedly overtime, we suggest a practical approach to guide patients’ management by assessing cardiac output, preload, and afterload using these methods. Near infrared spectroscopy is described as a method to assess end organ perfusion.