Bavare Aarti C, Rafie Kimia S, Bastero Patricia X, Hagan Joseph L, Checchia Paul A
1Section of Critical Care Medicine and Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, TX. 2Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston, TX. 3Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX. 4Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Pediatr Crit Care Med. 2017 May;18(5):414-419. doi: 10.1097/PCC.0000000000001117.
We studied rapid response events after acute clinical instability outside ICU settings in pediatric cardiac patients. Our objective was to describe the characteristics and outcomes after rapid response events in this high-risk cohort and elucidate the cardiac conditions and risk factors associated with worse outcomes.
A retrospective single-center study was carried out over a 3-year period from July 2011 to June 2014.
Referral high-volume pediatric cardiac center located within a tertiary academic pediatric hospital.
All rapid response events that occurred during the study period were reviewed to identify rapid response events in cardiac patients.
None.
We reviewed 1,906 rapid response events to identify 152 rapid response events that occurred in 127 pediatric cardiac patients. Congenital heart disease was the baseline diagnosis in 74% events (single ventricle, 28%; biventricle physiology, 46%). Seventy-four percent had a cardiac surgery before rapid response, 37% had ICU stay within previous 7 days, and acute kidney injury was noted in 41% post rapid response. Cardiac and/or pulmonary arrest occurred during rapid response in 8.5%. Overall, 81% were transferred to ICU, 22% had critical deterioration (ventilation or vasopressors within 12 hr of transfer), and 56% received such support and/or invasive procedures within 72 hours. Mortality within 30 days post event was 14%. Significant outcome associations included: single ventricle physiology-increased need for invasive procedures and mortality (adjusted odds ratio, 2.58; p = 0.02); multiple rapid response triggers-increased ICU transfer and interventions at 72 hours; critical deterioration-cardiopulmonary arrest and mortality; and acute kidney injury-cardiopulmonary arrest and need for hemodynamic support.
Congenital heart disease, previous cardiac surgery, and recent discharge from ICU were common among pediatric cardiac rapid responses. Progression to cardiopulmonary arrest during rapid response, need for ICU care, kidney injury after rapid response, and mortality were high. Single ventricle physiology was independently associated with increased mortality.
我们研究了小儿心脏病患者在重症监护病房（ICU）以外的急性临床不稳定后的快速反应事件。我们的目的是描述这一高危队列中快速反应事件后的特征和结局，并阐明与较差结局相关的心脏状况和危险因素。
在2011年7月至2014年6月的3年期间进行了一项回顾性单中心研究。
位于一家三级学术儿科医院内的高转诊量小儿心脏中心。
对研究期间发生的所有快速反应事件进行回顾，以确定心脏病患者的快速反应事件。
无。
我们回顾了1906起快速反应事件，以确定127例小儿心脏病患者发生的152起快速反应事件。74%的事件基线诊断为先天性心脏病（单心室，28%；双心室生理状态，46%）。74%的患者在快速反应前接受过心脏手术，37%的患者在之前7天内入住过ICU，41%的患者在快速反应后出现急性肾损伤。8.5%的患者在快速反应期间发生心脏和/或呼吸骤停。总体而言，81%的患者被转入ICU，22%的患者出现病情严重恶化（转入后12小时内需要通气或使用血管升压药），56%的患者在72小时内接受了此类支持和/或侵入性操作。事件发生后30天内的死亡率为14%。显著的结局关联包括：单心室生理状态——侵入性操作需求增加和死亡率升高（调整后的优势比，2.58；p = 0.02）；多个快速反应触发因素——72小时内ICU转入和干预增加；病情严重恶化——心肺骤停和死亡率；以及急性肾损伤——心肺骤停和血流动力学支持需求。
先天性心脏病、既往心脏手术和近期从ICU出院在小儿心脏快速反应中很常见。快速反应期间进展为心肺骤停、需要ICU护理、快速反应后肾损伤以及死亡率都很高。单心室生理状态与死亡率增加独立相关。
