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Management of Pediatric Shock

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"last update: 1 December  2025"                                                                                 Download Guideline

- References

 1. Davis A, Carcillo J, Aneja R, et al. American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Crit Care Med. 2017;45(6): 1061-1093.

2. Aneja R, Carcillo J. Differences between adult and pediatric septic shock. Minerva anestesiologica. 2011;77:986–92.

3. RecogniIon of shock. In: Pediatric Advanced Life Support Provider Manual, Chameides L, Samson RA, Schexnayder SM, Hazinski MF (Eds), American Heart AssociaIon, 2011.

4. Waltzman M. IniIal management of shock in children. Uptodate. 2016. www.uptodate.com.

5. MarIn K, Weiss SL. IniIal resuscitaIon and management of pediatric septic shock. Minerva Pediatr. 2015;67(2):141-158.

6. Hartman ME, L-ZW, Angus DC, Watson RS. Trends in the epidemiology of pediatric severe

sepsis. Pediatric Critical Care Medicine. 2013;14:686–93.

7. Brissaud O, Botte A, Cambonie G, et al. Experts’ recommendations for the management of

cardiogenic shock in children. Ann. Intensive Care. 2016; 6(1):14-29.

8. Simons F, Motohiro Ebisawa M, Sanchez-Borges M, et al. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. World Allergy Organ J. 2015; 8(1):32-47.

9. Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. The New England journal of medicine. 2003;348:138–50.

10. Weiss S, Peters M, Alhazzani W, et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med. 2020;21(2):e52-106.

11. Levitov A, Frankel H, Blaivas M, et al. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients—Part II: Cardiac Ultrasonography. Crit Care Med.2016;44(6):1206-1227.

12. Muraro A, Roberts G, Worm M, et al., EAACI Food Allergy and Anaphylaxis Guidelines Group. Anaphylaxis: Guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014; 69(8):1026-1045.

13. Campbell RL, Li JT, Nicklas RA, Sadosty AT; members of the joint task force; pracIce parameter workgroup. Emergency department diagnosis and treatment of anaphylaxis: a practice parameter. Ann Allergy Asthma Immunol. 2014;113(6):599-608.

14. Fleming JT, Clark S, Camargo CA, Rudders SA. Early treatment of food induced anaphylaxis with epinephrine is associated with a lower risk of hospitalizaIon. J Allergy Clin Immunol Pract. 2015;3:57–62.

15. Xu YS, Kastner M, Harada L, Xu A, Salter J, Waserman S. Anaphylaxis-related deaths in Ontario: a retrospecIve review of cases from 1986 to 2011.Allergy Asthma Clin Immunol. 2014;10:38.

16. Fathi E, Narchi H, Chedid F. Noninvasive hemodynamic monitoring of septic shock in children. World J Methodol. 2018;8(1):1-8.

17. Boluyt N, Bollen CW, Bos AP, Kok JH, Offringa M. Fluid resuscitation in neonatal and pediatric hypovolemic shock: a Dutch Pediatric Society evidence-based clinical practice guideline. Intensive Care Med. 2006;32(7):995.

18. Frankel H, Kirkpatrick A, Elbarbary M, et al. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part I: General Ultrasonography. Crit Care Med. 2015;43(11):2479-2502.

19. Simons FE, Ardusso LR, Bilò MB, El-Gamal YM, Ledford DK, Ring J, et al. World allergy organization guidelines for the assessment and management of anaphylaxis. [World Allergy Organ J. 2011;4(2):13-37.

20. University of Iowa, Stead family children hospital, PICU handbook https://uichildrens.org/health-library/continuous-infusions-picu-chart

21. Simons FER, Gu X, Silver NA, Simons KJ. EpiPen Jr versus EpiPen in young children weighing 15 to 30 kg at risk for anaphylaxis. J Allergy Clin Immunol. 2002;109:171–175.

22. Rodríguez-Núñez A, Oulego-Erroz I, Gil-Antón J, et al. Continuous terlipressin infusion as rescue treatment in a case series of children with refractory septic shock. Ann Pharmacother.

2310;44(10):1545-1553.

24. Kirk R, Dipchand A, Rosenthal D, et al. The International Society for Heart and Lung Transplantation Guidelines for the management of pediatric heart failure. J Heart Lung Transplant. 2014;33(9):888-909

25. Abdel Baky A, Omar TEI, Amer YS; Egyptian Pediatric Clinical Practice Guidelines Committee (EPG). Adapting global evidence-based practice guidelines to the Egyptian healthcare context: the Egyptian Pediatric Clinical Practice Guidelines Committee (EPG) initiative. Bull Natl Res Cent. 2023;47(1):88. https://doi.org/10.1186%2Fs42269-023-01059-0.

26. Alshehri A, Almazrou S, Amer Y. Methodological frameworks for adapting global practice guidelines to national context in the Eastern Mediterranean Region. Eastern Mediterranean Health Journal. 2023 Jul 1;29(7). https://www.emro.who.int/emhj-volume-29-2023/volume-29-issue-7/methodological-frameworks-for-adapting-global-practice-guidelines-to-national-context-in-the-eastern-mediterranean-region.html

27. Schünemann H, Brozek J, Guyatt G, Oxman A (editors). GRADE handbook: handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group; 2013 (Online updated version: https://gdt.gradepro.org/app/handbook/handbook.html Accessed 16/8/2024)

28. Klugar M, Lotfi T, Darzi AJ, et al. GRADE Guidance 39: Using GRADE-ADOLOPMENT to adopt, adapt or create contextualized recommendations from source guidelines and evidence syntheses. Journal of Clinical Epidemiology. 2024 Aug 6:111494. https://doi.org/10.1016/j.jclinepi.2024.111494 (in press).

29. Amer YS, Elzalabany MM, Omar TI, Ibrahim AG, Dowidar NL. The ‘Adapted ADAPTE’: an approach to improve utilization of the ADAPTE guideline adaptation resource toolkit in the A lexandria C enter for E vidence‐B ased C linical P ractice G uidelines. Journal of evaluation in clinical practice. 2015 Dec;21(6):1095-106. https://doi.org/10.1111/jep.12479.

30. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, Fervers B, Graham ID, Grimshaw J, Hanna SE, Littlejohns P, Makarski J, Zitzelsberger L; AGREE Next Steps Consortium. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010 Dec 14;182(18):E839-42. https://doi.org/10.1503%2Fcmaj.090449.

31. Agree II (2022) AGREE Enterprise website. Available at: https://www.agreetrust.org/resource-centre/agree-ii/  (Accessed: 16/8/2024).

32. Song Y, Alonso-Coello P, Ballesteros M, et al. A Reporting Tool for Adapted Guidelines in Health Care: The RIGHT-Ad@pt Checklist[J]. Annals of Internal Medicine, 2022, 175(5):710-719. https://doi.org/10.7326/M21-4352  (Official RIGHT Statement Website: http://www.right-statement.org/extensions/13 Accessed 16/8/2024).

References of materials used in creating this EBCPG
1. ADAPTE Resource Toolkit versions 2.0 (2009) Available from: www.g-i-n.net/documentstore/adapte-resource-toolkit-guideline-adaptation-version-2 (Version 2.0 downloaded free without registration).
2.  Yasser Sami Amer YS, Elzalabany MM, Omar TEI, Ibrahim AG and Dowidar NL.The ‘Adapted ADAPTE’:an approach to improve utilization of the ADAPTE guideline adaptation resource toolkit in the Alexandria Center for Evidence-Based Clinical Practice Guidelines. Journal of Evaluation in Clinical PracIce 2015; 21: 1095 – 1106.
3.  AGREE (II) Instrument available from the www.agreecollaboration.org/instrument/.21
The following are source guideline(s)
(used to produce the final single adapted CPG):
ACCM: (1)
Davis A, Carcillo J, Aneja R, et al. American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Crit Care Med. 2017;45(6): 1061-1093

SSC: (10)

Weiss S, Peters M, Alhazzani W, et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med. 2020;21(2):e52-106.

ISHLT: (23)

Kirk R, Dipchand A, Rosenthal D, et al. The International Society for Heart and Lung Transplantation Guidelines for the management of pediatric heart failure. J Heart Lung Transplant. 2014;33(9):888-909.

US: (18)(11).

Frankel H, Kirkpatrick A, Elbarbary M, et al. Guidelines for the Appropriate Use of Bedside

General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part I: General

Ultrasonography. Crit Care Med. 2015;43(11):2479-2502.

Levitov A, Frankel H, Blaivas M, et al. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients—Part II: Cardiac Ultrasonography. Crit Care Med.2016;44(6):1206-1227.

EAACI: (12)

Muraro A, Roberts G, Worm M, et al., EAACI Food Allergy and Anaphylaxis Guidelines Group. Anaphylaxis: Guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014; 69(8):1026-1045.

EDP-Ana: (13)

Campbell RL, Li JT, Nicklas RA, Sadosty AT; members of the joint task force; practice parameter workgroup. Emergency department diagnosis and treatment of anaphylaxis: a practice parameter. Ann Allergy Asthma Immunol. 2014;113(6):599-608.