Pediatric septic shock requires rapid recognition of cardiovascular failure and timely treatment to restore adequate tissue perfusion. Vasoactive medications are central to management, yet considerable uncertainty remains regarding the optimal first‑line agent. Although guidelines recommend tailoring vasoactive choice to a patient’s underlying physiology, substantial variation in practice persists across institutions. This variability may delay the initiation of therapy that best matches a child’s shock physiology, potentially prolonging instability and increasing the risk of organ dysfunction.
Accurate bedside assessment of shock physiology is therefore essential. Cardiac point‑of‑care ultrasound (POCUS) offers a rapid, real‑time view of cardiac function and has the potential to guide more precise early treatment. However, how cardiac POCUS is integrated into routine care and how it influences early vasoactive decisions remain poorly understood.
The overall objective of this study is to leverage the PEDSnet multicenter registry to characterize real‑world variation in early vasoactive medication selection for pediatric septic shock and to determine how use of cardiac POCUS is associated with management patterns and clinical outcomes across institutions. Our central hypothesis is that substantial inter‑site variability exists in early vasoactive choice and that early use of cardiac POCUS is associated with more targeted vasoactive selection and improved outcomes.
Aims:
Aim 1: Characterize practice variation in vasoactive medication selection for pediatric septic shock across participating sites using retrospective registry data.
Aim 2: To evaluate the association between early cardiac point‑of‑care ultrasound (POCUS) use, vasoactive medication selection, and clinical outcomes in pediatric septic shock.