Division of Critical Care Medicine (J.J.L., P.A.C., J.E., L.S.S.), Texas Children's Hospital, Baylor College of Medicine, Houston.
Division of Cardiology (J.J.L., A.G.C., J.F.P.), Texas Children's Hospital, Baylor College of Medicine, Houston.
Circ Heart Fail. 2020 Apr;13(4):e006101. doi: 10.1161/CIRCHEARTFAILURE.119.006101. Epub 2020 Apr 17.
Acute decompensated heart failure (ADHF) is a highly morbid condition among adults. Little is known about outcomes in children with ADHF. We analyzed the Pediatric Cardiac Critical Care Consortium registry to determine the epidemiology, contemporary treatments, and predictors of mortality in critically ill children with ADHF.
Cardiac intensive care unit (CICU) patients ≤18 years of age meeting Pediatric Cardiac Critical Care Consortium criteria for ADHF were included. ADHF was defined as systolic or diastolic dysfunction requiring continuous vasoactive or diuretic infusion, respiratory support, or mechanical circulatory support. Demographics, diagnosis, therapies, complications, and mortality are described for the cohort. Predictors of CICU mortality were identified using logistic regression.
Among 26 294 consecutive admissions (23 centers), 1494 (6%) met criteria for analysis. Median age was 0.93 years (interquartile range, 0.1-9.3 years). Patients with congenital heart disease (CHD) comprised 57% of the cohort. Common therapies included the following: vasoactive infusions (88%), central venous catheters (86%), mechanical ventilation (59%), and high flow nasal cannula (46%). Common complications were arrhythmias (19%), cardiac arrest (10%), sepsis (7%), and acute renal failure requiring dialysis (3%). Median length of CICU stay was 7.9 days (interquartile range, 3-18 days) and the CICU readmission rate was 22%. Overall, CICU mortality was 15% although higher for patients with CHD versus non-CHD (19% versus 11%; <0.001). Independent risk factors associated with CICU mortality included age <30 days, CHD, vasoactive infusions, ventricular tachycardia, mechanical ventilation, sepsis, pulmonary hypertension, extracorporeal membrane oxygenation, and cardiac arrest.
ADHF in children is characterized by comorbidities, high mortality rates, and frequent readmission, especially among patients with CHD. Opportunities exist to determine best practices around appropriate use of mechanical support, cardiac arrest prevention, and optimal heart transplantation candidacy to improve outcomes for these patients.
急性失代偿性心力衰竭（ADHF）是成年人中一种高度病态的病症。对于患有 ADHF 的儿童的结局，人们知之甚少。我们分析了儿科心脏危重病护理联合会的登记处，以确定患有严重 ADHF 的危重病儿童的流行病学、当代治疗方法和死亡率预测因素。
纳入年龄≤18 岁符合儿科心脏危重病护理联合会 ADHF 标准的心脏重症监护病房（CICU）患者。ADHF 的定义为需要持续血管活性或利尿剂输注、呼吸支持或机械循环支持的收缩或舒张功能障碍。描述了该队列的人口统计学、诊断、治疗、并发症和死亡率。使用逻辑回归确定 CICU 死亡率的预测因素。
在 26294 例连续入院患者（23 个中心）中，有 1494 例（6%）符合分析标准。中位年龄为 0.93 岁（四分位距，0.1-9.3 岁）。患有先天性心脏病（CHD）的患者占队列的 57%。常见的治疗方法包括以下内容：血管活性输注（88%）、中心静脉导管（86%）、机械通气（59%）和高流量鼻导管（46%）。常见并发症包括心律失常（19%）、心脏骤停（10%）、败血症（7%）和需要透析的急性肾衰竭（3%）。CICU 住院中位时间为 7.9 天（四分位距，3-18 天），CICU 再入院率为 22%。总体而言，CICU 死亡率为 15%，但 CHD 患者的死亡率高于非 CHD 患者（19%对 11%；<0.001）。与 CICU 死亡率相关的独立危险因素包括年龄<30 天、CHD、血管活性输注、室性心动过速、机械通气、败血症、肺动脉高压、体外膜氧合和心脏骤停。
儿童 ADHF 的特点是合并症、高死亡率和频繁再入院，尤其是在 CHD 患者中。有机会确定在适当使用机械支持、预防心脏骤停和确定最佳心脏移植候选者方面的最佳实践，以改善这些患者的结局。
