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High fever (hyperpyrexia) in children significantly worsens shock, leading to irreversible conditions. Prompt fever reduction and circulatory support are crucial for improving outcomes and reducing mortality.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular physiology
- Infectious disease pathology
Context:
- Hyperpyrexia is a critical factor in pediatric shock, particularly in early childhood.
- Infants' high arterial resistance contributes to circulatory impairment during fever.
- Vasoconstriction in febrile children increases risks of hypoxia and heat loss.
Purpose:
- To investigate the role of hyperpyrexia in pediatric shock.
- To elucidate the mechanisms of circulatory failure in febrile children.
- To evaluate the efficacy of systematic therapeutic interventions.
Summary:
- Hyperpyrexia exacerbates shock in children by impairing microcirculation and homeostasis through mechanisms like shivering and disseminated intravascular coagulation (DIC).
- Meningococcal sepsis often presents with vasoconstrictive shock and DIC in febrile children.
- Effective management requires fever control, circulatory support, and specific treatments for complications like DIC and cerebral edema.
Impact:
- Systematic treatment of hyperpyrexia and shock has significantly reduced fatality rates from 10% to 3%.
- Highlights the importance of integrated management strategies for febrile children in shock.
- Provides a framework for optimizing care in pediatric critical illness associated with high fever.
Abstract:
In childhood hyperpyrexia is the most important factor causing the irreversibility of shock. The combination of high fever and circulatory impairment is more frequent during the first years of life. This behaviour is due to the high resistance of the arterial system in infancy. Marked general vasoconstriction increases the risk of a reduction in circulation and of heat loss, and causes hypoxia and rise of fever. The further course of shock is largely determined by microcirculatory failures. Under hyperpyrexia the disturbance of homeostasis can be intensified by shivering, blocking of perspiratio sensibilis, hyperosmolarity, brain edema, and DIC. In most cases of meningococcal sepsis shock and DIC begin with vasoconstrictive centralisation of circulation. The high-output-shock is extremely rare in children with high fever. The control of all important functions of a febril child in shock is the best baseline for the treatment. It is necessary in all shock patients in hyperpyrexia to reduce the fever and to repair the peripheral circulation. The therapy consists of antipyretic drugs, physical cooling, infusions of buffer-bases, dopamine, antibiotics and so on. In DIC heparin or streptokinase are indicated. In severe circulatory impairment combined with high fever prednisone is useful, in brain edema dexamethasone. The fatality rate of our cases has been diminished by a systematic therapy of hyperpyrexia and shock from 10 to 3 percent.