Principles of care for the patient in shock (pediatrics)

Shock is defined as a syndrome with inadequate tissue oxygenation. Therapeutic efforts therefore try to establish a balance between the supply and the actual need for oxygen. Oxygen consumption is reduced by intubation, mechanical ventilation, sedation, myorelaxation, control of hyperpyrexia. On the other hand the oxygen supply is increased by oxygen therapy with either non-invasive or invasive airway management.


 * CVP 5 to 10 cm H2O
 * PAWP 7 to 15 cm H2O
 * age-appropriate values MAP and PerP
 * CI 3 to 6 l/min/m2
 * SvcO2 > 70 %
 * O2ER < 30 %
 * minimization of myocardial damage – physiological standards of AST, troponin, CK-MB, ECG, echokardiography
 * adequate airiness of the lungs
 * lactate < 2 mmol/l

Nezbytné je myslet na možné komplikace šokových stavů:
 * ARDS
 * DIC
 * akutní renální insuficience
 * akutní jaterní insuficience
 * ischémie myokardu
 * edém CNS
 * rabdomyolýza
 * pankreatitida
 * sepse
 * metabolické poruchy

Uvedené komplikace jsou známkou rozvoje MODS (multiple organ dysfunction syndrom) a výrazně zvyšují morbiditu a mortalitu pacientů.

Zdroj

 * HAVRÁNEK, Jiří: Šok. (upraveno)

Související články

 * Šok (pediatrie)
 * Šok