Haemodynamic support of paediatric patients in septic shock

Paediatric septic shock results in myocardial dysfunction, abnormalities of vascular tone and permeability and inadequate oxygen delivery. After fluid resuscitation has been completed for the initial hyperdynamic/low systemic vascular resistance phase, in many children the haemodynamic profile may change to one of low cardiac output with high systemic vascular resistance. This progression is of considerable importance to paediatric intensivists, because it necessitates a change in treatment strategy from vigorous fluid resuscitation and administration of α-agonist vasopressor medications to relative fluid restriction, and perhaps the administration of inotropic medications to increase myocardial contractility and vasodilators with the aim of reducing afterload.