To synthesize current evidence on the assessment and management of arterial hypotension in critically ill infants and children (beyond the neonatal period) and to translate these concepts into a structured, clinically applicable framework.
Key Findings:
Arterial hypotension is a late sign of decompensated shock associated with increased mortality and adverse neurologic outcomes.
Mean arterial pressure (MAP) is the preferred parameter for assessment and therapeutic guidance, with a pragmatic target of at least the 10th percentile for age recommended.
Early assessment using multimodal parameters, including cardiac point-of-care ultrasound, is essential for effective management.
Initial management should focus on rapid differentiation of shock etiology, judicious fluid resuscitation, and early initiation of vasoactive therapy to prevent fluid overload.
Interpretation:
Norepinephrine is supported as a first-line agent in distributive shock, with therapy tailored to the patient's underlying physiology and response.
Limitations:
The review does not address patients with congenital heart disease or those in the perioperative cardiac surgical setting, which may limit applicability.
Figures, tables, and clinical algorithms are derived from previously published studies and do not represent original data.
Conclusion:
This review provides a structured, evidence-based framework to support the bedside assessment and management of arterial hypotension in critically ill children.
