Clinical profile and outcome of shock in mechanically ventilated patients in pediatric intensive care unit of tertiary care centre

Abstract

Background: The clinical syndrome of shock, a clinical state characterized by inadequate tissue perfusion, is one of the most dramatic, dynamic and life-threatening problems faced by the physician in the critical care setting.Methods: Retrospective observational study of all critically ill children between 1month-12years who were admitted and mechanically ventilated in our 8-bedded PICU between January 2015 to June 2016; and had clinical evidence of shock. PIM3 (Paediatric Index of Mortality 3) was calculated. Authors noted morbidity and mortality pattern in all types of shock including outcome in Paediatric ICU. The data collected were compiled and tabulated.Results: The frequency of shock in authors’ Paediatric intensive care unit was 8.6% (n=780). However, among mechanically ventilated patients it was present in 65.5% patients. Septic shock was the most commonly encountered shock (n=48, 61.5%). Mortality was highest in cardiogenic shock (n=12, 80%) and obstructive shock (n=4, 80%). Survival was best in Hypovolemic shock. Authors found significant correlation between LOS MV and mortality (p=0.018). Type of shock had no correlation with PIM3 score (p=0.374) and mortality (p=0.884). Blood culture yield was positive in 26.9% patients with Klebsiella pneumoniae, Pseudomonas aeruginosa and MRSA being most common organisms isolated.Conclusions: Shock is a major cause of morbidity and mortality in children especially below 5yrs of age. Septic shock was the commonest form of shock in children. Severe pneumonia was the commonest illness causing septic shock. Mortality was associated with longer length of stay on mechanical ventilation. Larger prospective multicentric study in developing countries is desirable.