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Shock in children
Last reviewed: 07.07.2025
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Shock is a pathological process accompanied by a progressive mismatch between oxygen supply and consumption, leading to disruption of aerobic glycolysis and a decrease in ATP formation, the deficiency of which leads to disruption of cell function. Clinically, shock is manifested by generalized circulatory disorders, most often characterized by progressive tissue perfusion insufficiency.
In children, the manifestation of shock is less distinct than in adults, since their compensatory mechanisms work effectively, and a decrease in blood pressure often occurs only at a late stage, when shock is no longer treatable. This is due to the physiological sympathicotonia of the child's body, mediated by the high activity of the sympathoadrenal system. Early diagnosis and treatment of shock can save the child's life.
Classification of shock
There are many classifications of shock, according to the leading trigger factor, the following types can be distinguished:
- hypovolemic;
- cardiogenic;
- obstructive;
- distributive (septic, anaphylactic, neurogenic).
Symptoms of shock
Pathogenetic stages of central and peripheral circulatory disorders in shock have clear clinical manifestations and can be detected in shock of any etiology. However, the specific cause of shock leaves its mark on the relationship between the stages and the duration of each of them. At a certain stage, shock of any etiology passes into a phase in which a vicious circle of pathological disorders may arise, exceeding the possibilities of independent restoration of perfusion and oxygen saturation of tissues. At this stage, a chain of pathological phenomena of complex and currently insufficiently studied mechanisms of disorders in the system of regulation of the aggregate state of blood up to thrombohemorrhagic syndrome arises.
In the early compensated stage, homeostatic mechanisms function to maintain the necessary perfusion of the "central" organs. At this stage, arterial pressure, diuresis, and cardiac function remain at a relatively normal level, but there are already symptoms of inadequate tissue perfusion. In the hypotensive stage, circulatory compensation is disrupted due to ischemia, endothelial damage, and the formation of toxic metabolites. This occurs in all organs and systems. When this process causes irreversible functional losses, the terminal or irreversible stage of shock is recorded. In clinical practice, along with the true irreversibility of shock, there may be conditions in which hidden causes can stimulate irreversibility. Eliminating them may allow patients to be transferred to the category with "reversible" shock.
Treatment of shock
Treatment of shock conditions in children aims to restore oxygen delivery to tissues and optimize the balance between tissue perfusion and metabolic tissue needs. This requires improving blood oxygenation, increasing cardiac output and its distribution, reducing tissue oxygen consumption, and correcting metabolic disorders. The intensive treatment program for a patient in shock includes the following medical actions:
- replenishment of the BCC deficit and ensuring optimal pre- and post-load;
- maintaining myocardial contractile function;
- respiratory support;
- analgosedation;
- use of steroid hormones;
- antibiotic therapy;
- prevention of reperfusion injury;
- correction of hemostasis disorders (hypo- and hyperglycemia, hypocalcemia, hyperkalemia and metabolic acidosis).
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