Noninvasive hemodynamic monitoring of septic shock in children

Table 1 Measurement of hemodynamic parameters using different non-invasive tools

Hemodynamic parameter	Echo	Trans-thoracicTrans-esophageal Doppler	Electrical cardiometry	NIRS
Preload (fluid responsiveness)
IVCDI	+	-	-	-
CI before and after fluid bolus	+	+	+	-
Afterload
SVRI	+	+	+	-
Contractility
CI	+	+	+	-
End-organ perfusion
rSO2	-	-	-	+

IVCDI: Inferior vena cava distensibility index; CI: Cardiac index; SVRI: Systemic vascular resistance index; rSO₂: Regional tissue oxygen saturation; NIRS: Near infra-red spectroscopy.

Table 2 Suggested therapy in response to measured hemodynamic parameters in children with septic shock

Hemodynamic parameters	Pathophysiological mechanism	Treatment
High SVRI, low CI and normal BP	Increased afterload Decreased contractility	Inodilators (milrinone, levosimendan)
Low SVRI, low CI and low BP	Decreased afterload Decreased contractility	Vasopressors (norepinephrine, epinephrine) Dobutamine if CI remains low
Low SVRI, high CI and low BP	Decreased afterload Good contractility	Vasopressors (norepinephrine or low dose vasopressin) Dobutamine or low dose epinephrine if CI decreased

SVRI: Systemic vascular resistance index; CI: Cardiac index; BP: Blood pressure.