چکیده مقاله
There are many challenges related to strategies for mechanical ventilation adjustment, the use of corticosteroids, plasma exchange, continuous kidney replacement therapy CKRT , ECMO, IVIG administration, and nutritional support in the management of patients with septic shock Respiratory Support: recent recommendations suggest early intubation in patients who remain fluid refractory, even before respiratory failure develops Etomidate should not be used for intubation In patients with acute respiratory failure who do not meet indications for intubation, non invasive ventilation NIV may be considered Mechanical ventilation settings should follow the criteria for pediatric acute respiratory failure if it occurs Endocrine Issues: if the patient's hemodynamics remain unstable despite fluids and vasopressors, or if adrenal insufficiency is diagnosed, intravenous hydrocortisone is recommended Blood glucose should preferably be maintained below 180 mg/dl Nutritional Care: nutritional support is of particular importance in septic shock Enteral feeding should not be discontinued solely due to the use of vasoactive inotropic agents, and early enteral feeding within the first 48 hours in the absence of abdominal contraindications is advised There is insufficient evidence to support or oppose the use of intralipids, vitamin C, or zinc supplementation Transfusion it is recommended to maintain hemoglobin levels preferably above 7 g/dl in septic shock Prophylactic use of other blood products is not advised Adjunctive Therapies no specific recommendations are made for plasma exchange However, early initiation of CKRT is emphasized for the prevention or treatment of fluid overload in septic shock that leads to organ dysfunction and does not respond to fluid restriction or diuretics Indications for venovenous ECMO include septic shock associated acute respiratory failure with refractory hypoxemia, while venoarterial ECMO is reserved for shock resistant to other therapies Other Therapies: additional interventions discussed include IVIG, pantoprazole for stress ulcer prophylaxis , and pharmacological or mechanical prophylaxis for deep vein thrombosis However, their routine use is not recommended
نویسندگان
زینب نجفی
Assistant Professor of Pediatric Intensive Care, Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
شیوه ارجاع
نجفی, زینب,1404,The Role of Adjunctive Therapies and Supportive Care in Septic Shock,37th International Congress on Pediatrics,Tehran
ارائهشده در
مجموعه مقالات سی و هفتمین کنگره بیماری های کودکان17 مهر 1404 · تهران