Pediatric Intensive Care Unit, 16499Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
Department of Pediatric Cardiology, 16499Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
J Intensive Care Med. 2021 Apr;36(4):392-403. doi: 10.1177/0885066620969350. Epub 2020 Nov 5.
Multisystem inflammatory syndrome associated with SARS-CoV-2 infection can lead to myocardial injury and shock in children, likely the result of a severe inflammatory state, and can mimic Kawasaki disease.
To describe the characteristics of shock and myocardial injury in children with confirmed or suspeted COVID-19 during the SARS-CoV-2 pandemic in Spain, including clinical presentation, laboratory and imaging findings, treatment, disease course, and outcome. An extensive literature review is provided.
Retrospective case series including all children (age 1 month-18 years) admitted to a pediatric intensive care unit in Madrid, Spain, between March 15 and April 30, 2020 with suspected or confirmed SARS-CoV-2 infection and shock.
Twelve previously healthy patients with shock, age 5 to 14 years, were included. All required volume resuscitation and 75% required vasoactive/inotropic support. Distributive shock was present on admission in 67% (n = 8), and 4 patients (33%) showed features of cardiogenic shock. Myocardial injury was diagnosed in 67% (n = 8) and ventricular dysfunction in 33% (n = 4). The most common symptoms on presentation were fever (100%), anorexia (100%), diarrhea (75%), and vomiting (75%). Five patients showed signs of Kawasaki disease but none met the criteria for the classic form. Laboratory findings revealed lymphopenia (83%), thrombocytopenia (83%), and increased inflammatory markers (100%). Respiratory status was not significantly impacted. Chest X-ray showed bilateral alveolar infiltrates in 7 (58%) and bilateral pneumonia in 3 (25%). COVID-19 was confirmed in 11 cases (92%). All received empirical therapy against COVID-19, thromboprophylaxis and immunomodulation. Median stay in the PICU and inpatient ward was 4.5 and 10 days, respectively. No patients died.
Multisystem inflammatory syndrome in children with COVID-19 can mimic Kawasaki disease and lead to a combination of distributive and cardiogenic shock, probably secondary to a hyperinflammatory state that remains to be precisely defined. Treatment strategies include hemodynamic support, empirical therapies against COVID-19, thromboprophylaxis, and immunomodulation.
与 SARS-CoV-2 感染相关的多系统炎症综合征可导致儿童心肌损伤和休克，可能是严重炎症状态的结果，并可模拟川崎病。
描述西班牙 SARS-CoV-2 大流行期间确诊或疑似 COVID-19 患儿休克和心肌损伤的特征，包括临床表现、实验室和影像学发现、治疗、病程和结局。提供了广泛的文献综述。
回顾性病例系列研究，纳入 2020 年 3 月 15 日至 4 月 30 日期间在西班牙马德里一家儿科重症监护病房因疑似或确诊 SARS-CoV-2 感染而休克的所有年龄在 1 个月至 18 岁的儿童。
共纳入 12 例先前健康的休克患儿，年龄 5 至 14 岁，均需容量复苏，75%需要血管活性/正性肌力支持。入院时表现为分布性休克 67%（n=8），4 例（33%）表现为心源性休克特征。诊断为心肌损伤 67%（n=8），心室功能障碍 33%（n=4）。就诊时最常见的症状为发热（100%）、厌食（100%）、腹泻（75%）和呕吐（75%）。5 例出现川崎病表现，但均不符合典型川崎病标准。实验室检查发现淋巴细胞减少（83%）、血小板减少（83%）和炎症标志物增加（100%）。呼吸状况无明显影响。胸部 X 线显示 7 例（58%）为双侧肺泡浸润，3 例（25%）为双侧肺炎。11 例（92%）确诊 COVID-19。所有患者均接受针对 COVID-19 的经验性治疗、血栓预防和免疫调节。儿科重症监护病房和住院病房的中位住院时间分别为 4.5 天和 10 天。无患者死亡。
COVID-19 患儿的多系统炎症综合征可模拟川崎病，并导致分布性和心源性休克的组合，可能是由尚未精确定义的高炎症状态引起的。治疗策略包括血流动力学支持、针对 COVID-19 的经验性治疗、血栓预防和免疫调节。
