RECOGNITION AND MANAGEMENT OF SHOCK IN THE PEDIATRIC INTENSIVE CARE UNIT

Uvod: šok je težak poremećaj cirkulacije što za posljedicu ima smanjenu perfuziju tkiva i organa. Najčešći uzroci šoka u dječjoj dobi su sepsa i hipovolemija Svrha rada: analizirati podatke pacijenata s dijagnozom šoka, liječenih na Odjelu intenzivnog liječenja djece u Klinici za pedijatriju Kliničkog bolničkog centra Rijeka u razdoblju od 1.1.2010. do 15.5.2019. Ispitanici i postupci: retrospektivna studija obuhvatila je 42 djece u dobi od 2 mjeseca do 18 godina s dijagnozom šoka. Jedno dijete bilo je dva puta hospitalizirano zbog šoka pa ukupan broj analiziranih slučajeva iznosi 43. Bolesnici su podijeljeni u pet dobnih skupina: 2– 12 mjeseci; 12 mjeseci – 3 godine; 4– 6 godina; 7 – 12 godina i 12 – 18 godina. Iz studije je isključena novorođenčad i bolesnici čija medicinska dokumentacija nije bila dostupna ili je bila nedostatna. Prikupljeni podaci su obrađeni u programskom sustavu Microsoft Office Excel te opisani metodama deskriptivne statistike. Rezultati: između ispitanika nema znatne razlike u spolu. 72% djece pripada dobi od dva mjeseca do šest godina života. Najčešća vrsta šoka je septički šok (49%), a slijede hipovolemijski (23%) i kardiogeni šok (21%). 69% ispitanika imalo je povišenu serumsku koncentraciju laktata (≥2.5 mmol/L). U laboratorijskim nalazima krvi kod prijema 53% djece imalo acidozu, 60.5% imalo je povišen CRP, 34.9% imalo je hiperglikemiju, 67% imalo je poremećaj broja leukocita, a 42% djece imalo je poremećaj broja trombocita. 61.1% djece primilo je dvojnu terapiju inotropima i vazopresorima. Hidrokortizon je primijenjen u 19% slučajeva septičkog šoka. Najčešći je bio smrtni ishod (67% slučajeva), s najvećim udjelom u dobnim skupinama od 2 – 12 mjeseci te 12 mjeseci – 3 godine Zaključak: Šok je praćen visokom smrtnošću u djece, te je od primarnog značaja njegovo rano prepoznavanje i liječenje te isto tako prepoznavanje pacijenata s rizičnim čimbenicima nepovoljnog ishoda .Introduction: Shock is a severe circulatory disorder that results in reduced tissue and organ perfusion. In children, the most common causes of shock are sepsis and hypovolaemia. Objective: to analyze data from patients with diagnosis of shock, admitted to Pediatric Intensive Care Unit at the Department of Pediatrics, University Hospital of Rijeka, from 1.1.2010. to 15.5.2019. Materials and methods: retrospective study included 42 children aged 2 months to 18 years with a diagnosed shock. One child was hospitalized twice for shock, hence the total number of cases analyzed was 43. Patients were divided into five age groups: 2- 12 months; 12 months - 3 years; 4-6 years; 7 - 12 years and 12 - 18 years. The study did not include cases of shock in newborns and patients whose medical documentation was not available or was insufficient. The collected data is processed in the Microsoft Office Excel program and described by the descriptive statistics methods. Results: there is no significant gender difference among the patients. 72% of children were between two months and six years of age. The most common type of shock is septic shock (49%) followed by hypovolemic (23%) and cardiogenic shock (21%). 69% of patients had elevated serum lactate concentration (≥2.5 mmol / L). 53% of children had low blood pH, 60.5% had elevated CRP, 34.9% had hyperglycemia, 67% had white blood cell count disorder and 42% of children had platelet count disorder. 61.1% of children received dual therapy with inotropes and vasopressors. Hydrocortisone was used in four cases of septic shock. Death was the most common outcome (67% of all cases) and it was greatest among age groups of 2-12 months and 12 months - 3 years. Conclusion: the shock is followed by high mortality in children and its early recognition and treatment is of primary importance, as well as recognition of patients with risk factors of adverse outcome