Department of Anesthesia and Intensive Care, A.O.U. "Policlinico-Vittorio Emanuele," Catania, Italy.
School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico," University of Catania, Catania, Italy.
Pediatr Crit Care Med. 2021 Mar 1;22(3):251-261. doi: 10.1097/PCC.0000000000002622.
We conducted a systematic review and meta-analysis to investigate the prognostic value of echocardiographic parameters in pediatric septic patients.
MEDLINE, PubMed, and EMBASE (last update April 5, 2020).
Observational studies of pediatric sepsis providing echocardiographic parameters in relation to mortality.
Echocardiography data were categorized as those describing left ventricular systolic or diastolic function, right ventricular function, and strain echocardiography parameters. Data from neonates and children were considered separately. Analysis is reported as standardized mean difference and 95% CI.
We included data from 14 articles (n = 5 neonates, n = 9 children). The fractional shortening was the most commonly reported variable (11 studies, n = 555 patients) and we did not identify an association with mortality (standardized mean difference 0.22, 95% CI [-0.02 to 0.47]; p = 0.07, I2 = 28%). In addition, we did not find any association with mortality also for left ventricular ejection fraction (nine studies, n = 417; standardized mean difference 0.06, 95% CI [-0.27 to 0.40]; p = 0.72, I2 = 51%), peak velocity of systolic mitral annular motion determined by tissue Doppler imaging wave (four studies, n = 178; standardized mean difference -0.01, 95% CI [-0.34 to 0.33]; p = 0.97, I2 = 0%), and myocardial performance index (five studies, n = 219; standardized mean difference -0.51, 95% CI [-1.10 to 0.08]; p = 0.09, I2 = 63%). However, in regard to left ventricular diastolic function, there was an association with mortality for higher early wave of transmitral flow/peak velocity of early diastolic mitral annular motion determined by tissue Doppler imaging ratio (four studies, n = 189, standardized mean difference -0.45, 95% CI [-0.80 to -0.10]; p = 0.01, I2 = 0%) or lower peak velocity of early diastolic mitral annular motion determined by tissue Doppler imaging wave (three studies, n = 159; standardized mean difference 0.49, 95% CI [0.13-0.85]; p = 0.008, I2 = 0%). We did not find any association with mortality for early wave of transmitral flow/late (atrial) wave of trans-mitral flow ratio (six studies, n = 273; standardized mean difference 0.28, 95% CI [-0.42 to 0.99]; p = 0.43, I2 = 81%) and peak velocity of systolic mitral annular motion determined by tissue Doppler imaging wave measured at the tricuspid annulus (three studies, n = 148; standardized mean difference -0.18, 95% CI [-0.53 to 0.17]; p = 0.32, I2 = 0%). Only a few studies were conducted with strain echocardiography.
This meta-analysis of echocardiography parameters in pediatric sepsis failed to find any association between the measures of left ventricular systolic or right ventricular function and mortality. However, mortality was associated with higher early wave of transmitral flow/peak velocity of early diastolic mitral annular motion determined by tissue Doppler imaging or lower peak velocity of early diastolic mitral annular motion determined by tissue Doppler imaging, indicating possible importance of left ventricular diastolic dysfunction. These are preliminary findings because of high clinical heterogeneity in the studies to date.
我们进行了系统评价和荟萃分析，以调查超声心动图参数在儿科脓毒症患者中的预后价值。
MEDLINE、PubMed 和 EMBASE（最后更新日期为 2020 年 4 月 5 日）。
观察性研究，提供与死亡率相关的超声心动图参数的儿科脓毒症。
将超声心动图数据分类为描述左心室收缩或舒张功能、右心室功能和应变超声心动图参数的参数。分别考虑新生儿和儿童的数据。分析报告为标准化均数差和 95%置信区间。
我们纳入了 14 篇文章的数据（新生儿 n=5，儿童 n=9）。短轴缩短率是最常报告的变量（11 项研究，n=555 例患者），我们没有发现与死亡率相关的关系（标准化均数差 0.22，95%置信区间-0.02 至 0.47；p=0.07，I2=28%）。此外，我们也没有发现左心室射血分数与死亡率相关（9 项研究，n=417；标准化均数差 0.06，95%置信区间-0.27 至 0.40；p=0.72，I2=51%）、组织多普勒成像波确定的收缩期二尖瓣环运动峰速度（四项研究，n=178；标准化均数差-0.01，95%置信区间-0.34 至 0.33；p=0.97，I2=0%）和心肌做功指数（五项研究，n=219；标准化均数差-0.51，95%置信区间-1.10 至 0.08；p=0.09，I2=63%）。然而，在左心室舒张功能方面，早期二尖瓣血流/组织多普勒成像波确定的早期舒张期二尖瓣环运动峰值速度比与死亡率相关（四项研究，n=189，标准化均数差-0.45，95%置信区间-0.80 至-0.10；p=0.01，I2=0%）或组织多普勒成像波确定的早期舒张期二尖瓣环运动峰值速度较低（三项研究，n=159；标准化均数差 0.49，95%置信区间 0.13-0.85；p=0.008，I2=0%）。我们没有发现早期二尖瓣血流/晚期（心房）二尖瓣血流比与死亡率相关（六项研究，n=273；标准化均数差 0.28，95%置信区间-0.42 至 0.99；p=0.43，I2=81%）和三尖瓣环测量的组织多普勒成像波确定的收缩期二尖瓣环运动峰值速度（三项研究，n=148；标准化均数差-0.18，95%置信区间-0.53 至 0.17；p=0.32，I2=0%）。只有少数研究使用了应变超声心动图。
这项儿科脓毒症超声心动图参数的荟萃分析未能发现左心室收缩或右心室功能的测量值与死亡率之间存在任何关联。然而，死亡率与较高的早期二尖瓣血流/组织多普勒成像波确定的早期舒张期二尖瓣环运动峰值速度或较低的组织多普勒成像波确定的早期舒张期二尖瓣环运动峰值速度相关，这表明左心室舒张功能障碍可能具有重要意义。由于迄今为止的研究存在很高的临床异质性，这些发现只是初步的。
