Inotropes--an overview

Management of septic shock in childhood

OBJECTIVE

The object of this review is to discuss the recognition and treatment of septic shock in children based on principles of resuscitation, antibiotic use and recent therapeutic advances.

METHODS

A comprehensive literature search combining these

METHODS

on-line searches of Ovid, PubMed, and Medline; hand searches of 25 international journals; a trawl of 26 textbooks; searches of reference lists of pertinent articles; and scans of abstracts of recent international meetings. Various national and international units were contacted with regard to current research therapeutic strategies, both published and unpublished.

CONCLUSIONS

Septic shock remains a leading cause of morbidity and mortality in children. Early administration of empirical antibiotic therapy reduces mortality. The keystone of resuscitation is aggressive volume replacement. Adjunctive therapies to modulate the inflammatory response may further enhance outcome, but do not replace principles of resuscitation.

The principles of augmenting the cardiac output in adults

Augmentation of the patient's cardiac output to optimize tissue oxygenation is a primary role of intensive and cardiac care nurses. This involves three approaches: the use of intravenous colloids and occasionally crystalloids, creating a passive stretching of the myocardium to increase cardiac output, the use of inotropic agents which directly stimulate the heart and finally and less commonly the use of cardiac assist devices, notably the intra aortic balloon pump. The choice of method will be dictated by the presenting clinical data and the perceived benefits to the patient of each approach. The role of nurses as part of the health care team is to practice safe, informed care, through an understanding of both the advantages and disadvantages of each approach to the clinical scenario encountered. This paper contains exploration of each of the three principles with a case study approach, allowing the reader to consider a variety of presenting clinical data and appropriate haemodynamic manipulation.