Department of Pediatrics - PICU, Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2021 Nov;165(4):428-434. doi: 10.5507/bp.2020.048. Epub 2020 Oct 22.
To non-invasively identify the hemodynamic changes in critically ill children during the first 48 h following initiation of mechanical ventilation by the ultrasound cardiac output monitor (USCOM) method and compare the data in children with pulmonary and non-pulmonary pathology.
This was a prospective observational study to evaluate the influence of mechanical ventilation on hemodynamic changes and to describe hemodynamic profiles of mechanically ventilated children. A total of 56 children with respiratory failure were included in the present study. Ventilated patients are divided into two groups. Group A (n=36) includes patients with pulmonary pathology. Group B (n=20) consists of patients with extra pulmonary etiology of respiratory failure. Hemodynamic parameters (cardiac index and systemic vascular resistance index) were evaluated using ultrasound cardiac output monitoring (USCOM 1A) immediately following initiation of mechanical ventilation and again at 6, 12, and 48 h. Pharmacological circulatory support (inotropes, vasopressors, levosimendan and phosphodiesterase III inhibitors) was individually and continuously modified based on real-time hemodynamic parameters and optimal fluid balance.
No significant differences in hemodynamic profiles were found between Group A and Group B.
The protective strategy of mechanical ventilation was not associated with significant differences in hemodynamic profiles between children ventilated for pulmonary and non-pulmonary pathologies.
Hemodynamically unstable children ventilated for pulmonary pathology with the protective strategy of mechanical ventilation had a greater requirement for inotropic and combined inotropic and vasoactive circulatory support than children ventilated for non-pulmonary causes of respiratory failure.
通过超声心输出量监测仪（USCOM）方法，非侵入性地识别机械通气开始后 48 小时内危重症儿童的血液动力学变化，并比较肺部和非肺部病理儿童的数据。
这是一项前瞻性观察研究，旨在评估机械通气对血液动力学变化的影响，并描述机械通气儿童的血液动力学特征。本研究共纳入 56 例呼吸衰竭患儿。通气患者分为两组。A 组（n=36）包括肺部疾病患者。B 组（n=20）由呼吸衰竭的非肺部病因患者组成。使用超声心输出量监测（USCOM 1A）在机械通气开始后立即以及在 6、12 和 48 小时时评估血液动力学参数（心指数和全身血管阻力指数）。根据实时血液动力学参数和最佳液体平衡，单独且持续调整（正性肌力药、血管加压药、左西孟旦和磷酸二酯酶 III 抑制剂）循环支持。
A 组和 B 组之间的血液动力学特征无显著差异。
机械通气的保护策略与肺部和非肺部病理通气儿童的血液动力学特征无显著差异。
接受机械通气的肺部病理血液动力学不稳定的儿童比接受非肺部呼吸衰竭原因通气的儿童更需要正性肌力药和正性肌力药联合血管活性循环支持。
