The document discusses the treatment of pneumonia-induced septic shock, highlighting the importance of hemodynamic monitoring in guiding therapy. It details the effects of vasopressin and calcium treatment on systemic vascular resistance (SVR), renal perfusion, and urinary output. The conclusion emphasizes the need for accurate evaluation of hemodynamic states to inform effective treatment decisions, particularly in neonates and children.

1. Pneumonia - Septic Shock
Result Serial measurements confirmed
Patient less responsive to volume. decreased SVR despite clinical exam
of cool extremities.
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2. Pneumonia - Septic Shock
Treatment
Vasopressin and Ca2+ added
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3. Pneumonia - Septic Shock
Result
Increased SVR resulted in increased kidney perfusion and subsequent
increased Urinary Output.
However…
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4. Pneumonia - Septic Shock
Based on continued “cool extremities” colleague
removed Vasopressin and Ca2+
Result
Patient developed decreased Urinary Output and suboptimal acidosis.
USCOM clearly showed (again) decreased SVR.
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5. Pneumonia - Septic Shock
Summary
Clinical signs may differ from the true hemodynamic state misleading
optimal treatment.
Conclusion
USCOM identified the hemodynamic effects of correct and incorrect
therapy and guided treatment appropriately.
“In both neonates and children, shock should be further evaluated and
resuscitation treatment guided by hemodynamic variables including
…….CO.”
Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update
from the American College of Critical Care Medicine*
Joe Brierley, MD; Joseph A. Carcillo, MD; Karen Choong, MD et al. Crit Care Med 2009 Vol. 37, No. 2
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