Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Background: pediatric shock carries a high mortality and during early stages, many of the clinical signs are subtle. Its recognition is difficult and requires high index of suspicion. Each of these clinical signs, when considered alone, have poor sensitivity and specificity for outcome prediction. Restoration of global hemodynamics does not always mean that adequate tissue perfusion is achieved. Objective: to evaluate the utility of perfusion index, oxygen delivery index, oxygen consumption index and lactate clearance in the management and outcome prediction in children with shock. Methods: this cross sectional study was conducted on 50 children diagnosed with shock and underwent clinical assessment (heart rate , blood pressure, capillary refill time, CVP), perfusion index detection using Masimo Rad 67 and cardiovascular assessment by ICON (CI, SVRI, Oxygen delivery index (DO2I), laboratory investigations (Scvo2, Lactate through ABG). Calculation of lactate clearance, Oxygen Consumption Index (VO2I) and global oxygen Extraction Ratio (go2ER) was done. Results: males constituted 68% of studied patients. Perfusion Index (PI) ranged from (0.03-2.2), serum lactate ranged from (0-16 mmol/L), lactate clearance ranged from (-52.4% to 95%), DO2I ranged from (148 -1566 ml /min/m2), VO2I ranged from (135 - 325 ml /min/m2), go2ER ranged from (0.14-0.92), cut offs for predicating morality at 12 hour post admission for PI, lactate, lactate clearance, VO2I was {u2264}0.88 (sensitivity 100%, specificity 100%), >3 (sensitivity 95%, specificity 93%), 20% (sensitivity 100%, specificity 100%), >159 (sensitivity 100%, specificity 100%) respectively

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