OBJECTIVE: Assess outcome in @entity1 treated with inotrope, vasopressor, and/or vasodilator therapy for reversal of fluid-refractory and persistent @entity326 . DESIGN: Survey; case series. SETTING: Three pediatric hospitals. @entity1 : Fifty consecutive @entity1 with fluid-refractory @entity326 with a pulmonary artery catheter within 6 hours of resuscitation. INTERVENTIONS: @entity1 were categorized according to hemodynamic state and use of inotrope, vasopressor, and/or vasodilator therapy to maintain cardiac index (CI) >3.3 L/min/m2 and systemic vascular resistance >800 dyne-sec/cm/m to reverse shock. OUTCOME MEASURES: Hemodynamic state, response to class of cardiovascular therapy, and mortality. RESULTS: After fluid resuscitation, 58% of the @entity1 had a low CI and responded to inotropic therapy with or without a vasodilator (group I), 20% had a high CI and low systemic vascular resistance and responded to vasopressor therapy alone (group II), and 22% had both vascular and @entity299 and responded to combined vasopressor and inotropic therapy (group III). Shock persisted in 36% of the @entity1 . Of the @entity1 in group I, 50% needed the addition of a vasodilator, and in group II, 50% of @entity1 needed the addition of an inotrope for evolving @entity296 . Four @entity1 showed a complete change in hemodynamic state and responded to a switch from inotrope to vasopressor therapy or vice versa. The overall 28-day survival rate was 80% (group I, 72%; group II, 90%; group III, 91%). CONCLUSIONS: Unlike adults, @entity1 with fluid-refractory shock are frequently hypodynamic and respond to inotrope and vasodilator therapy. Because hemodynamic states are heterogeneous and change with time, an incorrect cardiovascular therapeutic regimen should be suspected in any @entity1 with persistent shock. Outcome can be improved compared with historical literature.

Hemodynamic support in fluid-refractory pediatric XXXX .

@entity1 :: ('9606', 'Species') :: ['children', 'Patients', 'patients', 'PATIENTS', 'child'] @entity296 :: ('MESH:D009202', 'Disease') :: ['myocardial dysfunction'] @entity299 :: ('MESH:D006331', 'Disease') :: ['cardiac dysfunction'] @entity326 :: ('MESH:D012772', 'Disease') :: ['septic shock']
@entity326 :: (MESH:D012772,Disease) :: ['septic shock']
