Vu Eric L, Rusin Craig G, Penny Dan J, Kibler Kathy K, Easley Ronald Blaine, Smith Brendan, Andropoulos Dean, Brady Ken
1Department of Pediatric Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.2Department of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
Pediatr Crit Care Med. 2017 Jan;18(1):44-53. doi: 10.1097/PCC.0000000000000980.
We evaluated ST-segment monitoring to detect clinical decompensation in infants with single ventricle anatomy. We proposed a signal processing algorithm for ST-segment instability and hypothesized that instability is associated with cardiopulmonary arrests.
Retrospective, observational study.
Tertiary children's hospital 21-bed cardiovascular ICU and 36-bed step-down unit.
Twenty single ventricle infants who received stage 1 palliation surgery between January 2013 and January 2014. Twenty rapid response events resulting in cardiopulmonary arrests (arrest group) were recorded in 13 subjects, and nine subjects had no interstage cardiopulmonary arrest (control group).
None.
Arrest data were collected over the 4-hour time window prior to cardiopulmonary arrest. Control data were collected from subjects with no interstage arrest using the 4-hour time window prior to cardiovascular ICU discharge. A paired subgroup analysis was performed comparing subject 4-hour windows prior to arrest (prearrest group) with 4-hour windows prior to discharge (postarrest group). Raw values of ST segments were compared between groups. A 3D ST-segment vector was created using three quasi-orthogonal leads (II, aVL, and V5). Magnitude and instability of this continuous vector were compared between groups. There was no significant difference in mean unprocessed ST-segment values in the arrest and control groups. Utilizing signal processing, there was an increase in the ST-vector magnitude (p = 0.02) and instability (p = 0.008) in the arrest group. In the paired subgroup analysis, there was an increase in the ST-vector magnitude (p = 0.05) and instability (p = 0.05) in the prearrest state compared with the postarrest state prior to discharge.
In single ventricle patients, increased ST instability and magnitude were associated with rapid response events that required intervention for cardiopulmonary arrest, whereas conventional ST-segment monitoring did not differentiate an arrest from control state.
我们评估了ST段监测在单心室解剖结构婴儿中检测临床失代偿的情况。我们提出了一种用于ST段不稳定的信号处理算法，并假设不稳定与心肺骤停有关。
回顾性观察研究。
三级儿童医院拥有21张床位的心血管重症监护病房和36张床位的降级护理病房。
20名单心室婴儿，于2013年1月至2014年1月期间接受了一期姑息手术。13名受试者记录了20次导致心肺骤停的快速反应事件（骤停组），9名受试者未发生阶段间心肺骤停（对照组）。
无。
在心肺骤停前4小时的时间窗内收集骤停数据。对照数据是从无阶段间骤停的受试者中，在心血管重症监护病房出院前4小时的时间窗内收集的。进行配对亚组分析，比较骤停前4小时时间窗（骤停前组）与出院前4小时时间窗（骤停后组）的受试者情况。比较两组间ST段的原始值。使用三个准正交导联（II、aVL和V5）创建三维ST段向量。比较该连续向量在两组间的大小和不稳定性。骤停组和对照组未经处理的ST段平均数值无显著差异。利用信号处理，骤停组的ST向量大小（p = 0.02）和不稳定性（p = 0.008）增加。在配对亚组分析中，与出院前的骤停后状态相比，骤停前状态的ST向量大小（p = 0.05）和不稳定性（p = 0.05）增加。
在单心室患者中，ST段不稳定性和大小增加与需要进行心肺骤停干预的快速反应事件相关，而传统的ST段监测无法区分骤停状态与对照状态。
