2016 Update for the Rogers' Textbook of Pediatric Intensive Care: Recognition and Initial Management of Shock

Objective: To review important articles in the field of pediatric shock and pediatric septic shock published subsequent to the Fifth Edition of the Rogers' Textbook of Pediatric Intensive Care. Data Sources: The U.S. National Library of Medicine PubMed (www.ncbi.nlm.nih.gov/pubmed) was searched for combination of the term "pediatric" and the following terms: "sepsis, septic shock, shock, antibiotics, extracorporeal membrane oxygenation, and steroid." The abstract lists generated by these searches were screened for potential inclusion. The authors were also aware of a number of key recent articles in pediatric shock, and these were also screened. Study Selection and Data Extraction: Promising articles published subsequent to the fifth edition of the textbook were included based on the consensus of the authors and via the peer review process. Data Extraction: Articles were grouped by category. Each author was assigned categories and extracted data from articles in that category. All authors contributed to final review of extracted data. Data Synthesis: Articles in the following categories were included: epidemiology and recognition of shock; laboratory markers of shock; antimicrobial therapy; vasoactive therapy; extracorporeal therapies; mortality patterns, prediction, and risk stratification; bundled approaches to shock recognition and management; and corticosteroid use. Conclusion: Research efforts in pediatric shock have largely centered on pediatric septic shock, with significant progress in the understanding of sepsis epidemiology, the use of extracorporeal therapies in critically ill children with sepsis, the role of hyperlactatemia and risk stratification in pediatric septic shock, and the impact of bundled care for pediatric sepsis, including evaluation of individual bundle elements such as the optimal timing of antibiotic administration and vasoactive medication choice. A consistent theme in the literature is the beneficial role of a bundled approach to septic shock recognition and management to improve both care and outcomes.