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362 SECTION IV Pediatric Critical Care Cardiovascular and ADAMTS 13 inhibitors 157,158 In a prospective observa tional study in 9 PICUs, the use of therapeutic plasma exchange in sepsis induced TAMOF[.]

362 S E C T I O N I V   Pediatric Critical Care: Cardiovascular and ADAMTS-13 inhibitors.157,158 In a prospective observational study in PICUs, the use of therapeutic plasma exchange in sepsis-induced TAMOF was associated with a decrease in organ dysfunction and a 55% lower adjusted relative risk of 28-day mortality as compared with those not receiving TPE.159 TPE could potentially have improved sepsis-induced organ dysfunction by removing inflammatory mediators, reducing antifibrinolytic molecules, replenishing anticoagulant proteins, and restoring ADAMTS-13 activity to mitigate the dysregulated inflammation, coagulation, and fibrinolytic pathways of sepsis.159 Summary Shock is a life-threatening condition that has a myriad of causes In order to survive shock, recognition and resuscitative efforts must be achieved early, the etiology elucidated, and ongoing monitoring and therapy instituted The astute clinician who recognizes shock, promptly establishes therapy, and continuously assesses response during treatment offers the child the best chance for a quality survival Key References Arikan AA, Zappitelli M, Goldstein SL, Naipaul A, Jefferson LS, Loftis LL Fluid overload is associated with impaired oxygenation and morbidity in critically ill children Pediatr Crit Care Med 2012;13(3):253-258 Carcillo JA, Kuch BA, Han YY, et al Mortality and functional morbidity after use of PALS/APLS by community physicians Pediatrics 2009;124(2):500-508 Davis AL, Carcillo JA, Aneja RK, et al The American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: executive summary Pediatr Crit Care Med 2017;18(9):884-890 Rhodes A, Evans LE, Alhazzani W, et al Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016 Crit Care Med 2016 Epub ahead of print Weiss SL, Peters MJ, Alhazzani W, et al Surviving Sepsis Campaign international guidelines for the management of septic shock and sepsisassociated organ dysfunction in children Pediatr Crit Care Med 2020;21(2):e52–e106 The full reference list for this chapter is available at ExpertConsult.com e1 References Weiss SL, Selak MA, Tuluc F, et al Mitochondrial dysfunction in peripheral blood mononuclear cells in pediatric septic shock Pediatr Crit Care Med 2015;16(1):E4-E12 Fink MP Bench-to-bedside review: cytopathic hypoxia Crit Care (London, England) 2002;6(6):491-499 Arques S, Ambrosi P, Gelisse R, Roux E, Lambert M, Habib G Prevalence of angiographic coronary artery disease in patients hospitalized for acute diastolic heart failure without clinical and electrocardiographic evidence of myocardial ischemia on admission Am J Cardiol 2004;94(1):133-135 Gaasch WH Diagnosis and treatment of heart failure based on left ventricular systolic or diastolic dysfunction JAMA 1994;271(16): 1276-1280 Ginghina C, Beladan CC, Iancu M, Calin A, Popescu BA Respiratory maneuvers in echocardiography: a review of clinical applications Cardiovasc Ultrasound 2009;7:42 Cohen J The immunopathogenesis of sepsis Nature 2002;420(6917): 885-891 Ceneviva G, Paschall JA, Maffei F, Carcillo JA Hemodynamic support in fluid-refractory pediatric septic shock Pediatrics 1998; 102(2):E19 Carcillo JA, Pollack MM, Ruttimann UE, Fields AI Sequential physiologic interactions in pediatric cardiogenic and septic shock Crit Care Med 1989;17(1):12-16 Parrillo JE, Parker MM, Natanson C, et al Septic shock in humans Ann Intern Med 1990;113(3):227-242 10 Cairns CB Rude unhinging of the machinery of life: metabolic approaches to hemorrhagic shock Curr Opin Crit Care 2001;7(6): 437-443 11 Fink MP Cytopathic hypoxia: is oxygen use impaired in sepsis as a result of an acquired intrinsic derangement in cellular respiration? 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