1 Division of Pediatric Critical Care Medicine, Emory University School of Medicine, Atlanta, GA, USA.
2 Division of Pediatric Cardiology, Emory University of School of Medicine, Atlanta, GA, USA.
J Intensive Care Med. 2019 Jan;34(1):17-25. doi: 10.1177/0885066616685247. Epub 2016 Dec 29.
: Myocardial dysfunction is a known complication in patients with pediatric septic shock (PSS); however, its clinical significance remains unclear. The purpose of this study was to characterize left ventricular (LV) and right ventricular (RV) dysfunction and their prevalence in patients with PSS using echocardiography (echo) and to investigate their associations with the severity of illness and clinical outcomes.
: Retrospective chart review between 2010 and 2015 from 2 tertiary care pediatric intensive care units. Study included 78 patients (mean age 9.3 ± 7 years) from birth up to 21 years who fulfilled criteria for fluid- and catecholamine-refractory septic shock. Echocardiographic parameters of systolic, diastolic, and global function were measured offline. They were correlated with admission Pediatric Risk of Mortality III (PRISM III) and Pediatric Logistic Organ Dysfunction scores, vasoactive-inotrope score (VIS), β-type natriuretic peptide (BNP), lactate, type of shock, duration of mechanical ventilation (MV), intensive care unit and hospital length of stay, and mortality.
: Overall, 28-day mortality was 26%, and 88% patients required MV. Prevalence of LV dysfunction was 72% and RV dysfunction was 63%. LV systolic dysfunction (fractional shortening z score <-2) was significantly associated with PRISM III, VIS, and BNP. RV systolic dysfunction (tricuspid annular plane systolic excursion z score <-2) was significantly associated with cold shock. LV and RV diastolic dysfunction did not have any significant clinical associations. No echocardiographic measures were associated with mortality.
: Myocardial dysfunction is highly prevalent in PSS but is not associated with mortality. LV systolic dysfunction is associated with a higher severity of illness, use of vasoactives, and BNP, whereas RV systolic dysfunction is associated with cold shock. Further studies are needed to determine the utility of echo in the bedside management of patients with PSS.
心肌功能障碍是小儿感染性休克（PSS）患者已知的并发症，但临床意义尚不清楚。本研究的目的是使用超声心动图描述 PSS 患者左心室（LV）和右心室（RV）功能障碍及其患病率，并探讨其与疾病严重程度和临床结局的关系。
对 2010 年至 2015 年 2 家三级儿科重症监护病房的病历进行回顾性分析。研究纳入了 78 名（平均年龄 9.3 ± 7 岁）从出生到 21 岁符合液体和儿茶酚胺难治性感染性休克标准的患者。离线测量收缩、舒张和整体功能的超声心动图参数。将其与入院时小儿危重评分（PRISM III）和小儿 Logistic 器官功能障碍评分、血管活性-正性肌力评分（VIS）、β型利钠肽（BNP）、乳酸、休克类型、机械通气（MV）时间、重症监护病房和住院时间及死亡率相关联。
总的来说，28 天死亡率为 26%，88%的患者需要 MV。LV 功能障碍的患病率为 72%，RV 功能障碍的患病率为 63%。LV 收缩功能障碍（分数缩短 z 评分 <-2）与 PRISM III、VIS 和 BNP 显著相关。RV 收缩功能障碍（三尖瓣环平面收缩位移 z 评分 <-2）与冷休克显著相关。LV 和 RV 舒张功能障碍与任何临床指标均无显著相关性。任何超声心动图指标均与死亡率无关。
心肌功能障碍在 PSS 中非常普遍，但与死亡率无关。LV 收缩功能障碍与疾病严重程度更高、血管活性药物的使用和 BNP 相关，而 RV 收缩功能障碍与冷休克相关。需要进一步的研究来确定超声心动图在 PSS 患者床边管理中的应用价值。
