Cutoff Values of Hemodynamic Parameters in Pediatric Refractory Septic Shock
Related Experiment Video
Updated: Sep 29, 2025
Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients
Published on: April 18, 2025
En-Pei Lee1,2, Jainn-Jim Lin1,2, Shao-Hsuan Hsia1,2
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan 333, Taiwan.
Insights
Systemic vascular resistance index (SVRI) and vasoactive-inotropic score (VIS) predict mortality in pediatric refractory septic shock. Low SVRI in early resuscitation identifies severe cases, guiding timely interventions for better outcomes.
Area of Science:
- Pediatric critical care medicine
- Pediatric intensive care
- Septic shock management
Background:
- Refractory septic shock poses significant risks in children, leading to severe morbidity and mortality.
- Hemodynamic monitoring is crucial for effective resuscitation in critically ill children.
- Early identification of hemodynamic profiles associated with poor prognosis is vital for timely intervention.
Purpose of the Study:
- To identify hemodynamic parameters in pediatric refractory septic shock that predict poor prognosis.
- To enable early interventions by understanding early hemodynamic indicators of severity.
- To analyze the association between hemodynamic variables and mortality in pediatric refractory septic shock.
Main Methods:
- Evaluation of children with refractory septic shock in a pediatric intensive care unit (PICU).
- Hemodynamic monitoring using a pulse index continuous cardiac output (PiCCO) system.
- Serial recording of cardiac index (CI), systemic vascular resistance index (SVRI), and vasoactive-inotropic score (VIS) within the first 72 hours of PICU admission.
Main Results:
- Thirty-three children with refractory septic shock were included in the study.
- Both SVRI and VIS were significantly associated with fatality (p < 0.05).
- Non-survivors exhibited lower serial SVRI and higher VIS compared to survivors.
- SVRI emerged as a significant predictor of mortality during the early resuscitative stage (first 36 hours).
Conclusions:
- Both SVRI and VIS serve as predictors of mortality in pediatric refractory septic shock.
- SVRI is identified as a powerful early predictor of mortality in the initial resuscitative phase.
- A persistently low SVRI may indicate disease severity, prompting adjustments in vasoactive-inotropic agent strategies to improve SVRI.
Abstract:
Background: Refractory septic shock can cause severe morbidities and mortalities in children. Resuscitation based on hemodynamics is important in children with critical illness. Thus, this study aimed to identify the hemodynamics of refractory septic shock associated with poor prognosis at an early stage to allow for timely interventions. Methods: We evaluated children with refractory septic shock admitted to a pediatric intensive care unit (PICU) and monitored their hemodynamics using a pulse index continuous cardiac output (PiCCO) system. The serial cardiac index (CI), systemic vascular resistance index (SVRI), and vasoactive−inotropic score (VIS) were recorded during the first 72 h after PICU admission. Results: Thirty-three children with refractory septic shock were enrolled. The SVRI and VIS were both associated with fatality from septic shock. The non-survivors had lower serial SVRI and higher VIS (both p < 0.05). Based on the area under the ROC curve, the SVRI was the predictor during the early resuscitative stage (first 36 h) in pediatric refractory septic shock. Conclusions: Both SVRI and VIS are predictors of mortality in children with refractory septic shock, and the SVRI is the powerful predictor of mortality in the early resuscitative stage. A low serial SVRI may allow for the early awareness of disease severity and strategies for adjusting vasoactive−inotropic agents to increase the SVRI.
