{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T03:47:21Z","timestamp":1789876041244,"version":"4.0.1"},"reference-count":130,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T00:00:00Z","timestamp":1770508800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Septic cardiomyopathy (SCM) is a dynamic and heterogeneous complication of sepsis, driven by systemic inflammation, autonomic dysregulation, and microcirculatory alterations. Pediatric and adult patients share common pathophysiologic mechanisms, but age-dependent differences in cardiovascular physiology produce distinct hemodynamic responses. Methods: A structured narrative review of clinical and experimental studies published between 2000 and 2025 was conducted via PubMed and major critical care literature. Studies were included if they addressed SCM pathophysiology, hemodynamic monitoring, and therapeutic strategies across age groups, while studies focusing on non-septic cardiac dysfunction were excluded. Results: Adult SCM often presents as hyperdynamic, vasoplegic states, whereas pediatric patients more frequently exhibit hypodynamic profiles, reflecting developmental differences in myocardial reserve and autonomic regulation. Evidence suggests that isolated conventional echocardiographic parameters may underestimate myocardial impairment, whereas advanced modalities, including myocardial strain echocardiography and multimodal hemodynamic monitoring, may serve as complementary tools to detect subtle or evolving myocardial dysfunction. Pediatric evidence remains limited, and therapeutic guidance is largely extrapolated from adult studies. Conclusions: SCM should be approached as a time-dependent, physiology-driven condition, requiring repeated, integrated multimodal cardiovascular assessment to guide individualized management. Age-specific hemodynamic profiles highlight the need for standardized diagnostics, prospective validation of monitoring tools, and phenotype-guided interventions to improve outcomes in both adult and pediatric sepsis.<\/jats:p>","DOI":"10.3390\/children13020239","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T09:41:02Z","timestamp":1770630062000},"page":"239","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Septic Cardiomyopathy: Age-Dependent Physiology and Hemodynamic Aspects\u2014A Narrative Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7622-202X","authenticated-orcid":false,"given":"Marianna","family":"Miliaraki","sequence":"first","affiliation":[{"name":"Division of Pediatric Intensive Care, School of Medicine, University of Crete, 71300 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0928-6183","authenticated-orcid":false,"given":"George","family":"Briassoulis","sequence":"additional","affiliation":[{"name":"Postgraduate Program \u201cEmergency and Intensive Care in Children, Adolescents and Young Adults\u201d, School of Medicine, University of Crete, 71300 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelia","family":"Dardamani","sequence":"additional","affiliation":[{"name":"Division of Pediatric Intensive Care, School of Medicine, University of Crete, 71300 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9789-9002","authenticated-orcid":false,"given":"Panagiotis","family":"Briassoulis","sequence":"additional","affiliation":[{"name":"Division of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0936-368X","authenticated-orcid":false,"given":"Stavroula","family":"Ilia","sequence":"additional","affiliation":[{"name":"Division of Pediatric Intensive Care, School of Medicine, University of Crete, 71300 Heraklion, Greece"},{"name":"Postgraduate Program \u201cEmergency and Intensive Care in Children, Adolescents and Young Adults\u201d, School of Medicine, University of Crete, 71300 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1097\/CCM.0000000000002851","article-title":"Septic Cardiomyopathy","volume":"46","author":"Beesley","year":"2018","journal-title":"Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1007\/s12098-022-04434-3","article-title":"Advances in Shock Management and Fluid Resuscitation in Children","volume":"90","author":"Gupta","year":"2023","journal-title":"Indian J. Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Lautz, A.J., and Zingarelli, B. (2019). Age-Dependent Myocardial Dysfunction in Critically Ill Patients: Role of Mitochondrial Dysfunction. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20143523"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jointm.2021.11.004","article-title":"Septic cardiomyopathy: Diagnosis and management","volume":"2","author":"Boissier","year":"2022","journal-title":"J. Intensive Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"\u0130pek, S., G\u00fcll\u00fc, U.U., G\u00fcng\u00f6r, \u015e., and G\u00fcll\u00fc, \u015e.D. (2025). Prognostic value of cardiac biomarkers and Phoenix criteria in pediatric sepsis: A retrospective cohort study. BMC Pediatr., 25.","DOI":"10.1186\/s12887-025-06374-1"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"100767","DOI":"10.1016\/j.cpcardiol.2020.100767","article-title":"Septic Cardiomyopathy: From Basics to Management Choices","volume":"46","author":"Ravikumar","year":"2021","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_7","first-page":"e1114","article-title":"Use of Speckle-Tracking Echocardiography in Septic Cardiomyopathy in Critically Ill Children: A Narrative Review","volume":"6","author":"Chan","year":"2024","journal-title":"Crit. Care Explor."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40560-024-00770-y","article-title":"Sepsis-induced cardiogenic shock: Controversies and evidence gaps in diagnosis and management","volume":"13","author":"Sato","year":"2025","journal-title":"J. Intensive Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s11886-020-01277-2","article-title":"Sepsis-Induced Cardiomyopathy: A Comprehensive Review","volume":"22","author":"Sternberg","year":"2020","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e5031","DOI":"10.1097\/MD.0000000000005031","article-title":"Prevalence and risk factors of sepsis-induced cardiomyopathy: A retrospective cohort study","volume":"95","author":"Sato","year":"2016","journal-title":"Medicine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e0263","DOI":"10.1097\/MD.0000000000010263","article-title":"Risk factors and outcomes of sepsis-induced myocardial dysfunction and stress-induced cardiomyopathy in sepsis or septic shock: A comparative retrospective study","volume":"97","author":"Jeong","year":"2018","journal-title":"Medicine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"23","DOI":"10.31083\/j.rcm2501023","article-title":"Septic Cardiomyopathy","volume":"25","author":"Zibar","year":"2024","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1007\/s00134-021-06595-9","article-title":"Current practice and evolving concepts in septic shock resuscitation","volume":"48","author":"Bakker","year":"2022","journal-title":"Intensive Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1001\/jama.2019.0071","article-title":"Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial","volume":"321","author":"Damiani","year":"2019","journal-title":"JAMA"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/s13054-020-2779-9","article-title":"Heterogeneity of Cardiovascular Response to Standardized Sepsis Resuscitation","volume":"24","author":"Guarracino","year":"2020","journal-title":"Crit. Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.jpeds.2013.09.027","article-title":"Myocardial dysfunction in pediatric septic shock","volume":"164","author":"Raj","year":"2014","journal-title":"J. Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s13613-024-01255-9","article-title":"Prevalence and prognosis of hyperdynamic left ventricular systolic function in septic patients: A systematic review and meta-analysis","volume":"14","author":"Sato","year":"2024","journal-title":"Ann. Intensive Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1001\/jama.2024.0179","article-title":"International Consensus Criteria for Pediatric Sepsis and Septic Shock","volume":"331","author":"Schlapbach","year":"2024","journal-title":"JAMA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1177\/08850666231180526","article-title":"Prevalence and Prognosis of Sepsis-Induced Cardiomyopathy: A Systematic Review and Meta-Analysis","volume":"38","author":"Hasegawa","year":"2023","journal-title":"J. Intensive Care Med."},{"key":"ref_20","first-page":"18","article-title":"Venous\u2013arterial CO2 difference in children with sepsis and its correlation with myocardial dysfunction","volume":"2019","author":"Carcillo","year":"2020","journal-title":"Qatar Med. J."},{"key":"ref_21","first-page":"87","article-title":"Sepsis-Induced Myocardial Dysfunction in Pediatric Septic Shock: Prevalence, Predictors, and Outcome\u2014A Prospective Observational Study","volume":"13","author":"Swami","year":"2021","journal-title":"J. Pediatr. Intensive Care"},{"key":"ref_22","first-page":"3613475","article-title":"Hemodynamic Analysis of Pediatric Septic Shock and Cardiogenic Shock Using Transpulmonary Thermodilution","volume":"2017","author":"Lee","year":"2017","journal-title":"BioMed Res. Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"9452","DOI":"10.12998\/wjcc.v9.i31.9452","article-title":"Incidence, prognosis, and risk factors of sepsis-induced cardiomyopathy","volume":"9","author":"Liang","year":"2021","journal-title":"World J. Clin. Cases"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/j.mayocp.2012.01.018","article-title":"Clinical Spectrum, Frequency, and Significance of Myocardial Dysfunction in Severe Sepsis and Septic Shock","volume":"87","author":"Pulido","year":"2012","journal-title":"Mayo Clin. Proc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"8875","DOI":"10.2147\/JIR.S521655","article-title":"Mechanisms and Targeted Therapeutic Strategies in Sepsis-Induced Myocardial Dysfunction: The Role of NLRP3 Inflammasome-Mediated Inflammation","volume":"18","author":"Yu","year":"2025","journal-title":"J. Inflamm. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"319.e9","DOI":"10.1016\/j.jcrc.2011.06.017","article-title":"Ventricular dysfunction and dilation in severe sepsis and septic shock: Relation to endothelial function and mortality","volume":"27","author":"Furian","year":"2012","journal-title":"J. Crit. Care"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.2147\/RMHP.S452803","article-title":"Types of Septic Cardiomyopathy: Prognosis and Influencing Factors\u2014A Clinical Study","volume":"17","author":"Lu","year":"2024","journal-title":"Risk Manag. Healthc. Policy"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Malomo, S., Oswald, T., Stephenson, E., Yip, A., Alway, T., Hadjivassilev, S., Coombs, S., Ellery, S., Lee, J., and James, R. (2025). Characterisation of Post-Sepsis Cardiomyopathy Using Cardiovascular Magnetic Resonance. Diagnostics, 15.","DOI":"10.3390\/diagnostics15080997"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Pamporis, K., Karakasis, P., Pantelidaki, A., Goutis, P.A., Grigoriou, K., Theofilis, P., Katsaouni, A., Botis, M., Karanikola, A.-E., and Milaras, N. (2025). Sepsis-Induced Cardiomyopathy and Cardiac Arrhythmias: Pathophysiology and Implications for Novel Therapeutic Approaches. Biomedicines, 13.","DOI":"10.3390\/biomedicines13112643"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1177\/0885066616685247","article-title":"Characterization of Myocardial Dysfunction in Fluid- and Catecholamine-Refractory Pediatric Septic Shock and Its Clinical Significance","volume":"34","author":"Williams","year":"2019","journal-title":"J. Intensive Care Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e370","DOI":"10.1097\/PCC.0000000000000249","article-title":"Prevalence and outcome of diastolic dysfunction in children with fluid refractory septic shock\u2014A prospective observational study","volume":"15","author":"Sankar","year":"2014","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1007\/s00134-017-4698-z","article-title":"Left ventricular systolic dysfunction during septic shock: The role of loading conditions","volume":"43","author":"Boissier","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1093\/tropej\/fmx105","article-title":"Prevalence and Outcome of Sepsis-induced Myocardial Dysfunction in Children with \u2018Sepsis\u2019 \u2018with\u2019 and \u2018Without Shock\u2019\u2014A Prospective Observational Study","volume":"64","author":"Jain","year":"2018","journal-title":"J. Trop. Pediatr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"103521","DOI":"10.1016\/j.amsu.2022.103521","article-title":"Characteristics of hemodynamic parameters after fluid resuscitation and vasoactive drugs administration in pediatric shock: A prospective observational study","volume":"76","author":"Yuliarto","year":"2022","journal-title":"Ann. Med. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Kuroshima, T., Kawaguchi, S., and Okada, M. (2024). Current Perspectives of Mitochondria in Sepsis-Induced Cardiomyopathy. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25094710"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e37940","DOI":"10.1097\/MD.0000000000037940","article-title":"Clinical implications of septic cardiomyopathy: A narrative review","volume":"103","author":"Hiraiwa","year":"2024","journal-title":"Medicine"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Carbone, F., Liberale, L., Preda, A., Schindler, T.H., and Montecucco, F. (2022). Septic Cardiomyopathy: From Pathophysiology to the Clinical Setting. Cells, 11.","DOI":"10.3390\/cells11182833"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1016\/j.bbadis.2018.10.011","article-title":"The role of mitochondria in sepsis-induced cardiomyopathy","volume":"1865","author":"Stanzani","year":"2019","journal-title":"Biochim. et Biophys. Acta (BBA)-Mol. Basis Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.yjmcc.2023.05.003","article-title":"NLRP3 inflammasome-driven IL-1\u03b2 and IL-18 contribute to lipopolysaccharide-induced septic cardiomyopathy","volume":"180","author":"Fujimura","year":"2023","journal-title":"J. Mol. Cell. Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s13062-025-00657-4","article-title":"Macrophage Notch1 drives septic cardiac dysfunction by impairing mitophagy and promoting NLRP3 activation","volume":"20","author":"Zheng","year":"2025","journal-title":"Biol. Direct"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2147","DOI":"10.1002\/ehf2.13938","article-title":"Characterization of critically ill patients with septic shock and sepsis-associated cardiomyopathy using cardiovascular MRI","volume":"9","author":"Muehlberg","year":"2022","journal-title":"ESC Heart Fail."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1038\/s41569-020-00492-2","article-title":"Pathophysiology of sepsis-induced cardiomyopathy","volume":"18","author":"Hollenberg","year":"2021","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1007\/s00392-011-0292-5","article-title":"Septic cardiomyopathy: Hemodynamic quantification, occurrence, and prognostic implications","volume":"100","author":"Werdan","year":"2011","journal-title":"Clin. Res. Cardiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s44158-025-00241-2","article-title":"Catecholamines in sepsis: Pharmacological insights and clinical applications\u2014A narrative review","volume":"5","author":"Belfiore","year":"2025","journal-title":"J. Anesth. Analg. Crit. Care"},{"key":"ref_45","first-page":"986","article-title":"Differences between adult and pediatric septic shock","volume":"77","author":"Aneja","year":"2011","journal-title":"Minerva Anestesiol"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1097\/PCC.0000000000002668","article-title":"Left Ventricular Diastolic Dysfunction in Pediatric Sepsis: Outcomes in a Single-Center Retrospective Cohort Study*","volume":"22","author":"Ginsburg","year":"2021","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/FJC.0b013e31822233dd","article-title":"Cardiovascular catecholamine receptors in children: Their significance in cardiac disease","volume":"58","author":"Buijs","year":"2011","journal-title":"J. Cardiovasc. Pharmacol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2593","DOI":"10.1113\/JP283792","article-title":"Adapting to a new environment: Postnatal maturation of the human cardiomyocyte","volume":"601","author":"Salameh","year":"2023","journal-title":"J. Physiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1186\/s13287-021-02252-6","article-title":"Mitochondria and metabolic transitions in cardiomyocytes: Lessons from development for stem cell-derived cardiomyocytes","volume":"12","author":"Garbern","year":"2021","journal-title":"Stem Cell Res. Ther."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"4759","DOI":"10.1007\/s00431-023-05236-1","article-title":"The effect of myocardial dysfunction on mortality in children with septic shock: A prospective observational study","volume":"182","author":"Soydan","year":"2023","journal-title":"Eur. J. Pediatr."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1097\/MOP.0000000000000337","article-title":"Pediatric Sepsis","volume":"28","author":"Mathias","year":"2016","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e17","DOI":"10.1097\/PCC.0b013e3182a5589c","article-title":"Multimodal monitoring for hemodynamic categorization and management of pediatric septic shock: A pilot observational study","volume":"15","author":"Ranjit","year":"2014","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s40477-024-00958-w","article-title":"The association between integrating echocardiography use in the management of septic shock patients and outcomes in the intensive care unit: A systematic review and meta-analysis","volume":"28","author":"Killu","year":"2025","journal-title":"J. Ultrasound"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1186\/s13054-022-04255-y","article-title":"A plea for personalization of the hemodynamic management of septic shock","volume":"26","author":"Cecconi","year":"2022","journal-title":"Crit. Care"},{"key":"ref_55","first-page":"1","article-title":"Echocardiography in the intensive care unit: An essential tool for diagnosis, monitoring and guiding clinical decision-making","volume":"14","author":"Pastore","year":"2021","journal-title":"Physiol. Int."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"961","DOI":"10.23736\/S0375-9393.25.19224-9","article-title":"Global longitudinal strain to early detect myocardial dysfunction in septic shock: A systematic review","volume":"91","author":"Garo","year":"2025","journal-title":"Minerva Anestesiol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1186\/s13613-025-01561-w","article-title":"Sepsis-induced myocardial dysfunction diagnosed with strain versus non-strain echocardiography parameters: Incidence, evolution and association with prognosis","volume":"15","author":"Gonzalez","year":"2025","journal-title":"Ann. Intensive Care"},{"key":"ref_58","first-page":"101339","article-title":"Mortality in patients with septic cardiomyopathy identified by longitudinal strain by speckle tracking echocardiography: An updated systematic review and meta-analysis with trial sequential analysis","volume":"43","author":"Pruszczyk","year":"2024","journal-title":"Anaesth. Crit. Care Pain Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e2294","DOI":"10.1097\/CCM.0000000000006844","article-title":"Time Course of Morbidity and Mortality Across Echocardiographic Phenotypes in Patients With Sepsis: A Systematic Review and Meta-Analysis","volume":"53","author":"Wang","year":"2025","journal-title":"Crit. Care Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.repc.2021.05.020","article-title":"Septic cardiomyopathy: A narrative review","volume":"42","author":"Lima","year":"2023","journal-title":"Rev. Port. de Cardiol."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Zhang, H., Gao, B., Liu, Y., Zhang, Q., and Wang, X. (2025). Patterns of left and right ventricular dysfunction and their clinical outcomes in septic patients. BMC Anesthesiol., 25.","DOI":"10.1186\/s12871-025-03233-5"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Zakynthinos, G.E., Giamouzis, G., Xanthopoulos, A., Oikonomou, E., Kalogeras, K., Karavidas, N., Dimeas, I.E., Gialamas, I., Gounaridi, M.I., and Siasos, G. (2025). Septic Cardiomyopathy: Difficult Definition, Challenging Diagnosis, Unclear Treatment. J. Clin. Med., 14.","DOI":"10.3390\/jcm14030986"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1016\/j.chest.2020.09.274","article-title":"Right Ventricular Dysfunction in Early Sepsis and Septic Shock","volume":"159","author":"Lanspa","year":"2021","journal-title":"Chest"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s40560-016-0148-1","article-title":"Sepsis-induced myocardial dysfunction: Pathophysiology and management","volume":"4","author":"Kakihana","year":"2016","journal-title":"J. Intensive Care"},{"key":"ref_65","first-page":"62","article-title":"Prognostic Implications of Left Ventricular Ejection Fraction Improvement in Patients with Heart Failure with Reduced and Mildly Reduced Ejection Fraction","volume":"42","author":"Chen","year":"2026","journal-title":"Acta Cardiol. Sin."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.echo.2014.09.009","article-title":"Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: A report from the American Society of Echocardiography","volume":"28","author":"Porter","year":"2015","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1097\/SHK.0000000000001877","article-title":"Echocardiographic Correlates of Mortality Among Cardiac Intensive Care Unit Patients With Cardiogenic Shock","volume":"57","author":"Jentzer","year":"2022","journal-title":"Shock"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Reveco, S., Barbagelata, S., Cruces, P., Diaz, F., Yohanessen, K., Larra\u00edn, M., Guerra, M., and Bataszew, A. (2025). Functional echocardiography identifies association between early ventricular dysfunction and outcome in pediatric sepsis. Front. Pediatr., 13.","DOI":"10.3389\/fped.2025.1570519"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1007\/s00134-013-3003-z","article-title":"Evolution of haemodynamics and outcome of fluid-refractory septic shock in children","volume":"39","author":"Deep","year":"2013","journal-title":"Intensive Care Med."},{"key":"ref_70","first-page":"460","article-title":"The use of bedside echocardiography for measuring cardiac index and systemic vascular resistance in pediatric patients with septic shock","volume":"30","author":"Abdalaziz","year":"2018","journal-title":"Rev. Bras. Ter. Intensiv."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Kim, J.-S., Kim, M., Kim, Y.-J., Ryoo, S.M., Sohn, C.H., Ahn, S., and Kim, W.Y. (2019). Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock. J. Clin. Med., 8.","DOI":"10.3390\/jcm8020239"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"e192","DOI":"10.1097\/PCC.0000000000002247","article-title":"Cardiac Dysfunction Identified by Strain Echocardiography Is Associated With Illness Severity in Pediatric Sepsis","volume":"21","author":"Patel","year":"2020","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1097\/SHK.0000000000002359","article-title":"Novel echocardiogram analysis of cardiac dysfunction is associated with mortality in pediatric sepsis","volume":"62","author":"Cater","year":"2024","journal-title":"Shock"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"R149","DOI":"10.1186\/cc13987","article-title":"Outcome prediction in sepsis: Speckle tracking echocardiography based assessment of myocardial function","volume":"18","author":"Orde","year":"2014","journal-title":"Crit. Care"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1186\/s13054-022-04173-z","article-title":"Effective hemodynamic monitoring","volume":"26","author":"Pinsky","year":"2022","journal-title":"Crit. Care"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1016\/j.aucc.2024.03.005","article-title":"Hemodynamic goals in sepsis and septic shock resuscitation: An umbrella review of systematic reviews and meta-analyses with trial sequential analysis","volume":"37","author":"Orso","year":"2024","journal-title":"Aust. Crit. Care"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s40560-015-0105-4","article-title":"Lactate kinetics in sepsis and septic shock: A review of the literature and rationale for further research","volume":"3","author":"Chertoff","year":"2015","journal-title":"J. Intensive Care"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1007\/s10238-025-01842-5","article-title":"From cardiac injury to omics signatures: A narrative review on biomarkers in septic cardiomyopathy","volume":"25","author":"Guarino","year":"2025","journal-title":"Clin. Exp. Med."},{"key":"ref_79","first-page":"e1303","article-title":"Dynamic Measures of Fluid Responsiveness to Guide Resuscitation in Patients With Sepsis and Septic Shock: A Systematic Review and Meta-Analysis","volume":"7","author":"Wang","year":"2025","journal-title":"Crit. Care Explor."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez-Sarmiento, J., Lamprea, S., Barrera, S., Acevedo, L., Duque, C., Trujillo, M., Aguirre, V., and Jimenez, C. (2024). The association between prolonged capillary refill time and microcirculation changes in children with sepsis. BMC Pediatr., 24.","DOI":"10.1186\/s12887-024-04524-5"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1186\/s40001-024-02074-1","article-title":"Chinese Critical Ultrasound Study Group (CCUSG) Early peripheral perfusion monitoring in septic shock","volume":"29","author":"Guo","year":"2024","journal-title":"Eur. J. Med. Res."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1097\/CCM.0b013e31819323c6","article-title":"Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine","volume":"37","author":"Brierley","year":"2009","journal-title":"Crit. Care Med."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"100515","DOI":"10.1016\/j.bjao.2025.100515","article-title":"Access to haemodynamic evaluation tools in middle-income countries: A survey of 1593 anaesthetists and intensivists from 39 nations","volume":"17","author":"Michard","year":"2026","journal-title":"BJA Open"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s10877-016-9823-y","article-title":"Reproducibility of transpulmonary thermodilution cardiac output measurements in clinical practice: A systematic review","volume":"31","author":"Giraud","year":"2017","journal-title":"J. Clin. Monit. Comput."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1017\/S1047951124026374","article-title":"Haemodynamic monitoring after paediatric cardiac surgery using echocardiography and PiCCO","volume":"34","author":"Pernbro","year":"2024","journal-title":"Cardiol. Young-"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1097\/PCC.0b013e3182070959","article-title":"Hemodynamic monitoring by transpulmonary thermodilution and pulse contour analysis in critically ill children","volume":"12","author":"Proulx","year":"2011","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1186\/s13054-017-1739-5","article-title":"Transpulmonary thermodilution: Advantages and limits","volume":"21","author":"Monnet","year":"2017","journal-title":"Crit. Care"},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Wang, Y., Shi, J., Hua, Z., and Xu, J. (2019). Cardiac output measurements via echocardiography versus thermodilution: A systematic review and meta-analysis. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0222105"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1007\/s00134-016-4258-y","article-title":"Systematic review of cardiac output measurements by echocardiography vs. thermodilution: The techniques are not interchangeable","volume":"42","author":"Wetterslev","year":"2016","journal-title":"Intensive Care Med."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1186\/s13054-020-03326-2","article-title":"Recommendations for hemodynamic monitoring for critically ill children\u2014Expert consensus statement issued by the cardiovascular dynamics section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)","volume":"24","author":"Singh","year":"2020","journal-title":"Crit. Care"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"R105","DOI":"10.1186\/cc9054","article-title":"Extravascular lung water index measurement in critically ill children does not correlate with a chest x-ray score of pulmonary edema","volume":"14","author":"Lemson","year":"2010","journal-title":"Crit. Care"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1111\/pan.12859","article-title":"Transpulmonary thermodilution (PiCCO) measurements in children without cardiopulmonary dysfunction: Large interindividual variation and conflicting reference values","volume":"26","author":"Grindheim","year":"2016","journal-title":"Pediatr. Anesth."},{"key":"ref_93","first-page":"274","article-title":"How to monitor cardiovascular function in critical illness in resource-limited settings","volume":"27","author":"Sivakorn","year":"2021","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"R204","DOI":"10.1186\/cc10421","article-title":"Precision of the transpulmonary thermodilution measurements","volume":"15","author":"Monnet","year":"2011","journal-title":"Crit. Care"},{"key":"ref_95","first-page":"103","article-title":"Echocardiography in low-resource rural tropical hospitals","volume":"41","author":"Bregani","year":"2011","journal-title":"Trop. Dr."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s10877-012-9410-9","article-title":"Cardiac output measured by uncalibrated arterial pressure waveform analysis by recently released software version 3.02 versus thermodilution in septic shock","volume":"27","author":"Slagt","year":"2013","journal-title":"J. Clin. Monit. Comput."},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Arteaga, G.M., and Crow, S. (2023). End organ perfusion and pediatric microcirculation assessment. Front. Pediatr., 11.","DOI":"10.3389\/fped.2023.1123405"},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Shvilkina, T., and Shapiro, N. (2023). Sepsis-Induced myocardial dysfunction: Heterogeneity of functional effects and clinical significance. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1200441"},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"Chiscano-Cam\u00f3n, L., Ruiz-Sanmartin, A., Baja\u00f1a, I., Bastidas, J., Lopez-Martinez, R., Franco-Jarava, C., Gonzalez, J.J., Larrosa, N., Riera, J., and Nuvials-Casals, X. (2024). Current perspectives in the management of sepsis and septic shock. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1431791"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1097\/SHK.0000000000002427","article-title":"OUTCOMES OF PEDIATRIC FLUID-REFRACTORY SEPTIC SHOCK ACCORDING TO DIFFERENT VASOACTIVE STRATEGIES: A SYSTEMATIC REVIEW AND META-ANALYSIS","volume":"62","author":"Marchetto","year":"2024","journal-title":"Shock"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1186\/s13054-020-03204-x","article-title":"Timing of norepinephrine initiation in patients with septic shock: A systematic review and meta-analysis","volume":"24","author":"Li","year":"2020","journal-title":"Crit. Care"},{"key":"ref_102","first-page":"e0815","article-title":"A Randomized Controlled Trial of Norepinephrine Plus Dobutamine Versus Epinephrine As First-Line Vasoactive Agents in Children With Fluid Refractory Cold Septic Shock","volume":"5","author":"Banothu","year":"2022","journal-title":"Crit. Care Explor."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1097\/PCC.0000000000001533","article-title":"Prevention of Low Cardiac Output Syndrome After Pediatric Cardiac Surgery: A Double-Blind Randomized Clinical Pilot Study Comparing Dobutamine and Milrinone*","volume":"19","author":"Hug","year":"2018","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1177\/1074248418797357","article-title":"Comparative Effectiveness and Safety Between Milrinone or Dobutamine as Initial Inotrope Therapy in Cardiogenic Shock","volume":"24","author":"Lewis","year":"2019","journal-title":"J. Cardiovasc. Pharmacol. Ther."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.bj.2021.10.004","article-title":"Hemodynamic monitoring and management of pediatric septic shock","volume":"45","author":"Lee","year":"2022","journal-title":"Biomed. J."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.jointm.2022.05.001","article-title":"Alternatives to norepinephrine in septic shock: Which agents and when?","volume":"2","author":"Jozwiak","year":"2022","journal-title":"J. Intensive Med."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1055\/s-0036-1583282","article-title":"Vasopressin in Pediatric Critical Care","volume":"5","author":"Choong","year":"2016","journal-title":"J. Pediatr. Intensive Care"},{"key":"ref_108","first-page":"101777","article-title":"Vasoactive drug use in children with community acquired septic shock in Australia and New Zealand","volume":"66","author":"Long","year":"2026","journal-title":"Lancet Reg. Health-West. Pac."},{"key":"ref_109","first-page":"e0036","article-title":"Synthetic Human Angiotensin II in Pediatric Patients With Vasodilatory Shock: A Report on Two Patients","volume":"1","author":"Bailey","year":"2019","journal-title":"Crit. Care Explor."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"e378","DOI":"10.1097\/PCC.0000000000002295","article-title":"Methylene Blue for Refractory Shock in Children: A Systematic Review and Survey Practice Analysis","volume":"21","author":"Johnson","year":"2020","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Alamami, A., Rahhal, A., Alqudah, B., Shebani, A., Alammora, A., Mohammad, H., Omar, A.S., and Shehatta, A.L. (2024). Clinical Outcomes of Angiotensin II Therapy in Vasoplegic Shock: A Systematic Review and Meta-Analysis. Life, 14.","DOI":"10.3390\/life14091085"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"20503121251413649","DOI":"10.1177\/20503121251413649","article-title":"Research progress on beta-blockers in the treatment of sepsis-induced cardiomyopathy: A mini review","volume":"14","author":"Huang","year":"2026","journal-title":"SAGE Open Med."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.21037\/jtd-23-823","article-title":"Prognostic implication of Vasoactive Inotropic Score in adult patients with cardiogenic shock on veno-arterial extracorporeal membrane oxygenation","volume":"16","author":"Hu","year":"2024","journal-title":"J. Thorac. Dis."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1007\/s13312-025-00130-5","article-title":"Vasoactive-Inotropic Score (VIS) and Outcome of Children with Pediatric Septic Shock","volume":"62","author":"Vikas","year":"2025","journal-title":"Indian Pediatr."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"1948","DOI":"10.1007\/s00134-016-4574-2","article-title":"Refractory septic shock in children: A European Society of Paediatric and Neonatal Intensive Care definition","volume":"42","author":"Morin","year":"2016","journal-title":"Intensive Care Med."},{"key":"ref_116","doi-asserted-by":"crossref","unstructured":"Lee, E.-P., Lin, J.-J., Hsia, S.-H., Chan, O.-W., Jan, S.-L., and Wu, H.-P. (2022). Cutoff Values of Hemodynamic Parameters in Pediatric Refractory Septic Shock. Children, 9.","DOI":"10.3390\/children9030303"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"154258","DOI":"10.1016\/j.jcrc.2023.154258","article-title":"Refractory septic shock and alternative wordings: A systematic review of literature","volume":"75","author":"Antonucci","year":"2023","journal-title":"J. Crit. Care"},{"key":"ref_118","doi-asserted-by":"crossref","unstructured":"Broman, L.M., Dubrovskaja, O., and Balik, M. (2023). Extracorporeal Membrane Oxygenation for Septic Shock in Adults and Children: A Narrative Review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12206661"},{"key":"ref_119","doi-asserted-by":"crossref","unstructured":"Torre, D.E., and Pirri, C. (2025). ECMO in Refractory Septic Shock: Patient Selection, Timing and Hemodynamic Targets. J. Clin. Med., 14.","DOI":"10.3390\/jcm14227904"},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.athoracsur.2025.01.040","article-title":"Definitions of Cardiogenic Shock and Indications for Temporary Mechanical Circulatory Support: Joint Consensus Report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society","volume":"120","author":"Grant","year":"2025","journal-title":"Ann. Thorac. Surg."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1186\/s13054-021-03668-5","article-title":"Venoarterial extracorporeal membrane oxygenation as mechanical circulatory support in adult septic shock: A systematic review and meta-analysis with individual participant data meta-regression analysis","volume":"25","author":"Ling","year":"2021","journal-title":"Crit. Care"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1097\/MAT.0000000000001464","article-title":"Extracorporeal Membrane Oxygenation for Septic Shock in Children","volume":"68","author":"Melnikov","year":"2022","journal-title":"Asaio J."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1177\/08850666231193357","article-title":"Peripheral Veno-Arterial-Extracorporeal Membrane Oxygenation for Refractory Septic Shock in Children: A Multicenter Review","volume":"39","author":"Warnock","year":"2024","journal-title":"J. Intensive Care Med."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1001\/archpedi.162.12.1164","article-title":"Cardiac function in pediatric septic shock survivors","volume":"162","author":"Knoester","year":"2008","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_125","doi-asserted-by":"crossref","unstructured":"Badke, C.M., Marsillio, L.E., Weese-Mayer, D.E., and Sanchez-Pinto, L.N. (2018). Autonomic Nervous System Dysfunction in Pediatric Sepsis. Front. Pediatr., 6.","DOI":"10.3389\/fped.2018.00280"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1161\/CIRCULATIONAHA.106.678359","article-title":"Sepsis and the Heart","volume":"116","author":"Merx","year":"2007","journal-title":"Circulation"},{"key":"ref_127","first-page":"e1242","article-title":"Electrocardiometry for the Management of Pediatric Septic Shock: A Pilot Randomized Controlled Trial","volume":"7","author":"Moharana","year":"2025","journal-title":"Crit. Care Explor."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5662\/wjm.v8.i1.1","article-title":"Noninvasive hemodynamic monitoring of septic shock in children","volume":"8","author":"Fathi","year":"2018","journal-title":"World J. Methodol."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"109","DOI":"10.5005\/jp-journals-10071-23340","article-title":"Longitudinal Study of CPK-MB and Echocardiographic Measures of Myocardial Dysfunction in Pediatric Sepsis: Are Patients with Shock Different from Those without?","volume":"24","author":"Baranwal","year":"2020","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"22579","DOI":"10.1038\/s41598-024-73112-5","article-title":"Association between the lactate-albumin ratio and microcirculation changes in Pediatric Septic patients","volume":"14","author":"Bustos","year":"2024","journal-title":"Sci. Rep."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/2\/239\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T10:21:42Z","timestamp":1770632502000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/2\/239"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,8]]},"references-count":130,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["children13020239"],"URL":"https:\/\/doi.org\/10.3390\/children13020239","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,8]]}}}