Study of prevalence, etiology, response to treatment and outcome of paediatric shock in a tertiary care hospital


  • S. Gobinathan Department of Paediatrics, Government Mohan Kumaramanglam Medical College and Hospital, Salem, Tamil Nadu India
  • K. Suresh Kannan Department of Paediatrics, Government Mohan Kumaramanglam Medical College and Hospital, Salem, Tamil Nadu India



Airway obstruction, Metabolic waste, oliguria, Septic shock


Background: Shock accounts for 2% of children admitted to Paediatric casualty worldwide as per most western literature and in Nelson text book of Paediatrics. About 10 million children die of shock every year in the world. Highest mortality is observed in under 5 children in developing countries. Clinical manifestations are due to decreased perfusion to tissues, the compensatory mechanisms that are triggered by the decreased perfusion and the inadequate removal of metabolic wastes. This study was carried out to assess the prevalence of paediatric shock in children admitted to Paediatric ICU, to identify possible aetiology and the response to treatment and outcome in patients admitted with shock in Paediatrics Department of Government Mohan Kumaramangalam Medical College, Hospital, and Salem.

Methods: All sick children admitted to Paediatric intensive care unit of Government Mohankumaramangalam Medical College Hospital, Salem with the suspicion of shock are assessed by using the rapid cardiopulmonary assessment and diagnosed suffering from shock. Possible etiology, type and severity of shock would be arrived at using a targeted history, clinical examination and relevant laboratory investigations.

Results: All children who had unstable airway or bradypnea, were having decompensated shock and except one among them all expired despite prompt airway management. Respiratory distress noticed in 23 (40.4%) of children and all of them had either cardiogenic, septic shock or a combination of both. Capillary refill time was prolonged in 52 (91.2%) of children and the remainder 5 (8.8%) had flash refill and managed as warm septic shock. Decompensated shock as evidenced by low blood pressure was seen in 57.9% children. All of them had altered mental status. Urinary output was monitored in 38 children of which 31 (81.6%) had oliguria.

Conclusions: Septic shock accounts for majority of decompensated shock and poor outcome to management. Infancy decompensated shock, septic shock and those requiring ventilator support were the factors influencing the outcome of management.


American Academy of Pediatrics. Pediatric Education for Prehospital Professionals. Elk Grove village IL Jones and Barletta; 2000:133-138.

American Heart Association. Recognition of shock and respiratory failure. In: Camelids L. Hazinski MF. Pediatric Advanced Life Support; 2006:347-352.

Brierley J, Carcillo JA, Choong K, Cornell T, Decaen A, Deymann A et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009;37(2):666-88.

Bollaert FE, Bauer P, Bert A. Effects of epinephrine on hemodynamics and oxygen metabolism in dopamine resistant shock. Chest. 1990;98(4):949-53.

Carrillo JA, Fields AT. American college of critical care medicine task force members. Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crist Care Med. 2002;30(16):1365-78.

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap): A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81.

Cochrane Injuries Group Albumin Reviews. Human albumin administration in critically ill patients: systematic review of randomised controlled trials BMJ. 1998;317:235-40.

Conran RS, Kumar V, Robbins SL. Shock in fluid and hemodynamic derangements. In: Robbins Pathologic Basis of Disease. WB Saunders; 1989:114-119.

Fleisher G, Ludwig S. Textbook of Pediatric Emergency Medicine. 4th ed. Philadelphia Lippincott; 2000.

Carcillo JA, Tasker RC. Fluid resuscitation in Hypovolemic shock: acute medicine's great triumph for children. Intensive Care Med. 2006;32(7):958-61.

Frankel LR. Mathers LH. Shock, In: Nelson Textbook of Pediatrics. 17th Edition. Philadelphia: Saunders; 2003.

Irwin RS, Rippe JM. Irwin and Rippe’s intensive care medicine, Philadelphia, Lippincott Williams and Wilkins; 2011.

Duke LT, Molineux EM. IV fluids for seriously ill children. Lamcet. 2003:362:1320-3.

McConnell MS Perkin RM. Shock states. In: Pediatric Critical Care. 2nd ed. Fuhrman BP, Zimmerman JJ. St. Louis, Mosby; 1998;293-305.

Murphy K. Pediatric Triage Guidelines. Mosby St. Louis; 1997.

Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R. SAFE study investigators. a comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350(22):2247-56.

Singh S. Shock. Principles of Pediatric and Neonatal emergencies 2nd ed. New Delhi: Jaypee Medical Publishers; 2006.

Tobin JR. Wetzel RC. Shock and multiorgan system failure. Textbook of Pediatric Intensive Care. 3rd Edition. Lippincott Williams and Wilkins; 2008;123-8.






Original Research Articles