Algorithm for time-sensitive, goal-directed stepwise management of hemodynamic support in newborns. Proceed to next step if shock persists. (1) First hour.

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Presentation transcript:

Algorithm for time-sensitive, goal-directed stepwise management of hemodynamic support in newborns. Proceed to next step if shock persists. (1) First hour goals—Restore and maintain heart rate thresholds, capillary refill appropriate; (2) Subsequent intensive care unit goals—If shock is not reversed, intervene to restore and maintain normal perfusion pressure (equal to MAP – CVP), preductal and postductal o2 saturation difference <5%, and either central venous o2 saturation (Scvo2) >70%, superior vena cava (SVC) flow >40 mL/kg/min, or cardiac index (CI) >3.3 L/min/m2 in neonatal intensive care unit (NICU). *See Chapter 122A, Pediatric Heart Disease: Congenital Heart Defects, for prostaglandin dosing and administration. CVP = central venous pressure, ECMO = extracorporeal membrane oxygenation; LV = left ventricular; MAP = mean arterial pressure, NRP = Neonatal Resuscitation Program; PDA = patent ductus arteriosus; PPHN = persistent pulmonary hypertension of newborn; RDS = respiratory distress syndrome; RV = right ventricular; T3 = triiodothyronine; VLBW = very-low-birth-weight. Source: Chapter 146. Septic Shock, Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e Citation: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e; 2011 Available at: https://accessmedicine.mhmedical.com/DownloadImage.aspx?image=/data/Books/tint/tint_c546f005.gif&sec=40396730&BookID=348&ChapterSecID=40381623&imagename= Accessed: October 30, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved