Paediatric Intensive Care Unit, Royal Children's Hospital, University of Melbourne, Department of Paediatrics, Murdoch Children's Research Institute, Parkville, VIC, Australia.
Department of Intensive Care, Royal Melbourne Hospital, Parkville, VIC, Australia.
Pediatr Crit Care Med. 2021 Jan 1;22(1):79-89. doi: 10.1097/PCC.0000000000002607.
To describe the hemodynamic response to fluid boluses for hypotension in children in a cardiac ICU.
A prospective, observational study.
Single-centered cardiac ICU.
Children in a cardiac ICU with hypotension.
Clinician prescribed fluid bolus.
Sixty-four fluid boluses were administered to 52 children. Fluid composition was 4% albumin in 36/64 (56%), 0.9% saline in 18/64 (28%), and cardiopulmonary bypass pump blood in 10/64 (16%). The median volume and duration were 5.0 mL/kg (interquartile range, 4.8-5.4) and 8 minutes (interquartile range, 4-19), respectively. Hypovolemia/low filling pressures was the most common additional indication (25/102 [25%]). Mean arterial pressure response, defined as a 10% increase from baseline, occurred in 42/64 (66%) of all fluid boluses at a median time of 6 minutes (interquartile range, 4-11). Mean arterial pressure responders had a median peak increase in the mean arterial pressure of 15 mm Hg (43 mm Hg [interquartile range, 29-50 mm Hg] to 58 mm Hg [interquartile range, 49-65 mm Hg]) at 17 minutes (interquartile range, 14-24 min) compared with 4 mm Hg (48 mm Hg [interquartile range, 40-51 mm Hg] to 52 mm Hg [interquartile range, 45-56 mm Hg]) at 10 minutes (interquartile range, 3-18 min) in nonresponders. Dissipation of mean arterial pressure response, when defined as a subsequent decrement in mean arterial pressure below 10%, 5%, and 2% increases from baseline, occurred in 28/42 (67%), 18/42 (43%), and 13/42 (31%) of mean arterial pressure responders, respectively. Cardiopulmonary bypass pump blood was strongly associated with peak change in mean arterial pressure from baseline (coefficient 11.0 [95% CI, 4.3-17.7]; p = 0.02). Fifty out of 64 (78%) were receiving a vasoactive agent. However, change in vasoactive inotrope score was not associated with change in mean arterial pressure (coefficient 2.3 [95% CI, -2.5 to -7.2]; p = 0.35). Timing from admission, nor fluid bolus duration, influenced mean arterial pressure response.
In children with hypotension in a cardiac ICU, the median dose and duration of fluid boluses were 5 mL/kg and 8 minutes. Peak response occurred shortly following administration and commonly returned to baseline.
描述心脏重症监护病房（ICU）中低血压患儿接受液体冲击治疗时的血液动力学反应。
前瞻性、观察性研究。
单中心心脏 ICU。
心脏 ICU 中出现低血压的患儿。
临床医生开具液体冲击治疗医嘱。
52 例患儿接受了 64 次液体冲击治疗。液体成分包括 4%白蛋白（36/64，56%）、0.9%生理盐水（18/64，28%）和心肺转流泵血（10/64，16%）。中位容量和持续时间分别为 5.0 毫升/公斤（四分位间距，4.8-5.4）和 8 分钟（四分位间距，4-19）。低血容量/低充盈压是最常见的附加指征（25/102，25%）。所有液体冲击中，有 42/64（66%）在中位时间 6 分钟（四分位间距，4-11）时出现平均动脉压增加 10%，定义为平均动脉压从基线增加 10%。平均动脉压反应者的平均动脉压峰值升高中位数为 15 毫米汞柱（43 毫米汞柱[四分位间距，29-50 毫米汞柱]至 58 毫米汞柱[四分位间距，49-65 毫米汞柱]），在 17 分钟（四分位间距，14-24 分钟）达到峰值，而非反应者在 10 分钟（四分位间距，3-18 分钟）时升高中位数为 4 毫米汞柱（48 毫米汞柱[四分位间距，40-51 毫米汞柱]至 52 毫米汞柱[四分位间距，45-56 毫米汞柱]）。平均动脉压反应的消退，当定义为平均动脉压随后下降至低于基线增加 10%、5%和 2%时，分别在 42/42（67%）、18/42（43%）和 13/42（31%）的平均动脉压反应者中发生。心肺转流泵血与平均动脉压从基线的峰值变化呈强相关（系数 11.0[95%CI，4.3-17.7]；p=0.02）。64 例中有 50 例（78%）正在接受血管活性药物治疗。然而，血管活性正性肌力药物评分的变化与平均动脉压的变化无关（系数 2.3[95%CI，-2.5 至-7.2]；p=0.35）。从入院到开始接受治疗的时间以及液体冲击的持续时间均不影响平均动脉压反应。
在心脏 ICU 中出现低血压的患儿中，液体冲击的中位剂量和持续时间为 5 毫升/公斤，持续 8 分钟。峰值反应在给药后不久发生，通常会恢复到基线水平。
