Septic shock in childrenSeptic shock is an inflammatory state resulting from a systemic response to bacterial infection. The decrease in peripheral resistance (vasodilatation) is the hallmark of early (hyper dynamic) stage of septic shock, this feature distinguishes it from other types of shock. Decreased peripheral resistance (vasodilatation) leads to a compensatory increase in cardiac output; therefore, cardiac output is maintained or some time increased despite of shock. Decreased peripheral resistance and increased cardiac output lead to increased blood flow and total oxygen delivery to the tissue. But, still, the tissues lack O2 due to local microcirculatory changes produced as a result of sepsis which causes decrease tissue extraction of oxygen. So, increased blood flow and cardiac out are still inadequate to meet the total metabolic needs of the tissue which are increased in sepsis. As sepsis progresses, hypo dynamic stage supervenes in which there is decreased cardiac output and increased peripheral resistance. So, hemodynamic changes in septic shock occur in two characteristic patterns, Early hyperdynamic and late hypo dynamic shock1) Early hyperdynamic shockHypotension is a late feature of septic shock and early hyperdynamic stage is characterized by normal or increased BR Other features are : - Tachycardia                                                                 Normal or increased cardiac output                        Tachypnea     Warm extremities  Decreased systemic vascular resistance    Increased pulmonary vascular resistance                                  2) Late hypo dynamic stageDecreased cardiac output                                          Hypotension                                                              Increased vascular resistance            Cool, mottled and often cyanotic extremities      Oliguria, renal failure    Hypothermia