Journal article
Refractory Shock in Pediatric Emergency Departments: Challenges and Innovations in Early Escalation: A Narrative Review
Sage Open Pediatrics, v 13
01 Jan 2026
PMID: 42244885
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Refractory shock in children carries persistently high mortality, particularly in low-resource settings. It occurs when circulatory failure persists despite adequate fluid resuscitation and vasoactive medications. This review summarizes pathophysiology, recognition, and escalation strategies for pediatric refractory shock, emphasizing early identification in the emergency department. It examines evidence for fluid management, vasoactive therapy, and point-of-care ultrasound in optimizing decision-making, along with second-line options such as corticosteroids, vasopressin, and milrinone. Special attention is given to resource-constrained settings, describing evidence-based adaptations including conservative fluid strategies from the FEAST trial, simplified algorithms, simulation-based training, and telemedicine. Improving outcomes requires rapid recognition, precise hemodynamic phenotyping, and timely evidence-based interventions.
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Details
- Title
- Refractory Shock in Pediatric Emergency Departments: Challenges and Innovations in Early Escalation: A Narrative Review
- Creators
- Eslam Abady - Tanta UniversitySarah C. Urbon - St. Christopher's Hospital for ChildrenElsayed S. Moubarak - Alzaiem Alazhari UniversityKevin Thomas Mathew - Alzaiem Alazhari UniversityKarim Fahmy - St. Christopher's Hospital for ChildrenFarah Deeba - Alfaisal UniversityMajd Oweidat - Hebron UniversityMohammed Hammad Jaber Amin - Alzaiem Alazhari UniversityMohammed Alsabri (Corresponding Author) - University of Modern Sciences
- Publication Details
- Sage Open Pediatrics, v 13
- Publisher
- SAGE Publications
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Emergency Medicine
- Web of Science ID
- WOS:001782247600001
- Scopus ID
- 2-s2.0-105041008322
- Other Identifier
- 991022196987404721
UN Sustainable Development Goals (SDGs)
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Source: SDGs in the Output
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Pediatrics