Related Experiment Video

Updated: Jun 6, 2026

A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
11:27

A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn

Published on: April 7, 2023

Refractory Shock in Pediatric Emergency Departments: Challenges and Innovations in Early Escalation: A Narrative

Eslam Abady1, Sarah C Urbon2, Elsayed S Moubarak3

  • 1Tanta University, Egypt.

Sage Open Pediatrics
|June 5, 2026
PubMed

Insights

Pediatric refractory shock, a critical condition with high mortality, requires prompt recognition and tailored interventions. This review highlights strategies for effective management, especially in resource-limited environments.

Area of Science:

  • Pediatric Critical Care Medicine
  • Emergency Medicine
  • Global Health

Background:

  • Refractory shock in children is a life-threatening condition with high mortality rates.
  • It is defined as persistent circulatory failure despite fluid resuscitation and vasoactive drugs.
  • Outcomes are particularly poor in low-resource settings.

Purpose of the Study:

  • To review the pathophysiology, recognition, and management strategies for pediatric refractory shock.
  • To emphasize early identification and intervention in emergency departments.
  • To discuss adaptations for resource-constrained settings.

Main Methods:

  • Literature review summarizing current evidence on pediatric refractory shock.
  • Examination of fluid management, vasoactive therapy, and point-of-care ultrasound.
  • Analysis of adaptations for low-resource settings, including conservative fluid strategies (FEAST trial).

Main Results:

  • Early recognition and precise hemodynamic phenotyping are crucial.
  • Evidence supports specific fluid and vasoactive therapies.
  • Second-line options like corticosteroids, vasopressin, and milrinone may be considered.
  • Resource-limited adaptations include conservative fluid strategies and simplified algorithms.

Conclusions:

  • Optimizing outcomes for pediatric refractory shock necessitates rapid recognition and evidence-based interventions.
  • Tailored management strategies are essential, particularly in resource-limited environments.
  • Integrating advanced tools like point-of-care ultrasound and telemedicine can improve care.

Keywords:
POCUScatecholamine-resistant shockfluid resuscitationhemodynamic monitoringmortality reductionpediatric refractory shockresource-limited settingsseptic shocktele-ICUvasoactive agents

More Related Videos

Description of a Swine Infant Model of Volume-Controlled Hemorrhagic Shock09:09

Description of a Swine Infant Model of Volume-Controlled Hemorrhagic Shock

Published on: November 3, 2023

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings06:59

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

Published on: November 9, 2016

Related Concept Videos

Cardiopulmonary Resuscitation IV: Pharmacological Management01:25

Cardiopulmonary Resuscitation IV: Pharmacological Management

Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
Cardiopulmonary Resuscitation III: AED Use01:23

Cardiopulmonary Resuscitation III: AED Use

Introduction to AEDAn Automated External Defibrillator (AED) is a portable medical device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock to help the heart re-establish an effective rhythm during sudden cardiac arrest (SCA). SCA occurs when the heart suddenly and unexpectedly stops beating, leading to a loss of blood flow to the brain and other vital organs. In such emergencies, time is of the essence, and using an AED, combined with Cardiopulmonary...
Acute Respiratory Failure-V01:29

Acute Respiratory Failure-V

The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Introduction Cardiac Emergencies01:30

Introduction Cardiac Emergencies

Cardiac emergencies are critical situations involving the heart that require immediate medical intervention to prevent severe complications or death. These emergencies often arise from underlying heart conditions that impair the heart's ability to function correctly.Types of Cardiac EmergenciesThe most common types of cardiac emergencies include Acute Coronary Syndrome (ACS), myocardial infarction (MI), cardiac arrest, and heart failure.Acute Coronary Syndrome (ACS)Acute Coronary Syndrome (ACS)...
Blood Pressure Imbalances and Circulatory Shock01:24

Blood Pressure Imbalances and Circulatory Shock

Disorders affecting blood volume, vascular tone, or vascular function can disrupt vascular homeostasis, including conditions like hypertension, hemorrhage, and shock.
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...