Vasodilatory shock in 15 years old girl in Bulgaria

Background Multisystem Inflammatory Syndrome in children related to COVID-19 (MIS-C) is a new condition the aftermath of which is yet to be studied both in Bulgaria and globally. Up to mid December 2020, world COVID-19 fatalities are put at 1 582 674, according WHO statistics. Case Presentation Summary We present a 15 years old patient with MIS-C, diagnosed with acute abdomen, operated andtreated for septic shock syndrome. The current situation represents a major clinical challenge in part due to the complex differential diagnosis involved: acute abdomen, septic shock, autoimmune diseases (Lupus erythematosus, Juvenile idiopathic arthritis, Kawasaki disease, Acquired immune deficiency, Crohn`s disease, Ulcer colitis), acute myocarditis. At the same time, other symptoms observed in children with COVID-19 such as skin rashes, lymphadenopathy, conjunctivitis are not presented inour patient. We did not observe any myocardial injury, however she went into an acute vasodilatory shock with tachycardia, reduced kidney perfusion pressure and oliguria. Learning Points/Discussion Effects of SARS-CoV-2 infection on patients will be asubject of analysis and clinical research. Differential diagnosisof the multisystem inflammation syndrome in children, clinicalexperience and newtherapeutic strategies are the key to reducing mortality and long-term complicationsin the affected patients.

Optimal target blood pressure in critically ill adult patients with vasodilatory shock: a protocol for a systematic review and meta-analysis

IntroductionThe optimal target of mean arterial pressure (MAP) for better outcomes in patients with vasodilatory shock remains a matter of debate. Although catecholamines are generally used to maintain target blood pressure in hypotensive patients with vasodilatory shock, the adverse effects of catecholamines must also be considered. We will perform a systematic review and meta-analysis of randomised controlled trials (RCTs) to assess the certainty of evidence determining the optimal target of MAP control for patients with vasodilatory shock in critically ill settings.Methods and analysisThis study protocol was registered in the University Hospital Medical Information Network Clinical Trials Registry. We will include only RCTs that evaluated the two different comparators for target MAP to be maintained for clinical outcomes of all-cause mortality: organ dysfunction and adverse events in critically ill adult patients with vasodilatory shock. We will search the electronic bibliographic databases of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials in November 2020. Two reviewers will independently screen titles and abstracts, perform full article reviews and extract study data. We will report study characteristics and assess methodological quality using the Cochrane Risk-of-Bias 2 tool. If pooling is appropriate, we will calculate relative risks with 95% CIs for all outcome measures. Clinical and methodological subgroup and sensitivity analyses will be performed to explore heterogeneity. Overall certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.Ethics and disseminationThis study will not involve primary data collection, and formal ethics approval will therefore not be required. We aim to publish this systematic review in a peer-reviewed journal.Trial registration numberUMIN000042624.