Karki Karan B, Towbin Jeffrey A, Harrell Camden, Tansey James, Krebs Joseph, Bigelow William, Saini Arun, Tadphale Sachin D
Division of Pediatric Critical Care Medicine, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, 38103, USA.
Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA.
Pediatr Cardiol. 2019 Jun;40(5):1046-1056. doi: 10.1007/s00246-019-02114-2. Epub 2019 May 7.
Acute heart failure (AHF) can cause low cardiac output and poor end-organ perfusion. Inotropic agents along with vasodilators can improve organ perfusion. Arginine vasopressin (AVP) and calcium chloride (CaCl) infusions are increasingly being used in low cardiac output states in pediatric AHF. We retrospectively reviewed 77 patients (0-18 years) with AHF admitted between January 2014 and May 2017 who received concurrent AVP and CaCl infusions. Surrogates of cardiac output and organ perfusion included hemodynamic vital signs, laboratory parameters, and urine output (UO). Organ dysfunction and vasopressor inotropic scores were also calculated. Median (IQR) age was 0.88 years (0, 3.75), and median weight was 6.62 kg (3.5, 13.7). Congenital heart disease was present in 70% (46/77) patients. Univentricular physiology was present in 25% (25/77) patients. None of the patients were in the immediate postoperative period. Median durations of AVP and CaCl were 2 days (1, 3) and 3 days (2, 6), respectively. Using Wilcoxon-signed rank test and Bonferroni correction, post hoc comparison showed that at 8 h post infusion, all systolic blood pressure (SBP) and diastolic blood pressure (DBP) results, and UO were greater than those 1 h prior to infusion. Median SBP increased from 79 mm Hg (71, 92) 1 h prior to 97 mm Hg (84, 107) 8 h post. Median DBP increased from 44 mm Hg (35, 52) 1 h prior to 54 mm Hg (44, 62) 8 h post. Heart rate showed a decrease between measurements 1 h prior to infusion and 8 h post, with median scores 146 (127, 162) and 136 (114, 150) beats per minute, respectively. Within first 8 h, median UO continuously increased from 6 mL/h. (0, 25) at 1 h post infusion to 20 mL/h. (2, 62) at 8 h post infusion. Median pediatric logarithmic organ dysfunction scores on days 4 through 7 post infusion were lower compared to day 1; median vasopressor inotropic scores on day 2 through 7 post infusion were lower compared to day 1. Serum lactate level, arterial pH, and base excess all showed favorable trend. Concurrent use of AVP and CaCl infusions may improve surrogates of cardiac output, and intensive care outcomes, and prevent organ dysfunction in children with AHF.
急性心力衰竭（AHF）可导致心输出量降低和终末器官灌注不良。正性肌力药物与血管扩张剂联合使用可改善器官灌注。精氨酸加压素（AVP）和氯化钙（CaCl）输注越来越多地用于小儿AHF的心输出量降低状态。我们回顾性分析了2014年1月至2017年5月期间收治的77例（0 - 18岁）接受AVP和CaCl联合输注的AHF患者。心输出量和器官灌注的替代指标包括血流动力学生命体征、实验室参数和尿量（UO）。还计算了器官功能障碍和血管升压正性肌力评分。中位（IQR）年龄为0.88岁（0，3.75），中位体重为6.62 kg（3.5，13.7）。70%（46/77）的患者患有先天性心脏病。25%（25/77）的患者存在单心室生理状态。所有患者均不在术后即刻。AVP和CaCl的中位输注时间分别为2天（1，3）和3天（2，6）。使用Wilcoxon符号秩检验和Bonferroni校正，事后比较显示，输注后8小时，所有收缩压（SBP）和舒张压（DBP）结果以及尿量均高于输注前1小时。SBP中位数从输注前1小时的79 mmHg（71，92）升至输注后8小时的97 mmHg（84，107）。DBP中位数从输注前1小时的44 mmHg（35，52）升至输注后8小时的54 mmHg（44，62）。心率在输注前1小时和输注后8小时的测量值之间有所下降，中位数分别为每分钟146次（127，162）和136次（114，150）。在最初8小时内，尿量中位数从输注后1小时的6 mL/h（0，25）持续增加至输注后8小时的20 mL/h（2，62）。输注后第4至7天的小儿对数器官功能障碍评分中位数低于第1天；输注后第2至7天的血管升压正性肌力评分中位数低于第1天。血清乳酸水平、动脉pH值和碱剩余均呈良好趋势。AVP和CaCl联合输注可能改善小儿AHF患者的心输出量替代指标、重症监护结局并预防器官功能障碍。
