Division of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Women's Hospital, 820 Sherbrook Street, Winnipeg, MB, R2016, R3A0L8, Canada.
Division of Neonatology, Department of Pediatrics and Child Health, McMaster University, Hamilton, Canada.
Eur J Pediatr. 2022 Mar;181(3):1277-1291. doi: 10.1007/s00431-021-04307-5. Epub 2021 Nov 8.
Physiologic-based management of hemodynamic instability is proven to guide the logical selection of cardiovascular support and shorten the time to clinical recovery compared to an empiric approach that ignores the heterogeneity of the hemodynamic instability related mechanisms. In this report, we classified neonatal hemodynamic instability, circulatory shock, and degree of compensation into five physiologic categories, based on different phenotypes of blood pressure (BP), other clinical parameters, echocardiography markers, and oxygen indices. This approach is focused on hemodynamic instability in infants with normal cardiac anatomy.Conclusion: The management of hemodynamic instability is challenging due to the complexity of the pathophysiology; integrating different monitoring techniques is essential to understand the underlying pathophysiologic mechanisms and formulate a physiologic-based medical recommendation and approach. What is Known: • Physiologic-based assessment of hemodynamics leads to targeted and pathophysiologic-based medical recommendations. What is New: • Hemodynamic instability in neonates can be categorized according to the underlying mechanism into five main categories, based on blood pressure phenotypes, systemic vascular resistance, and myocardial performance. • The new classification helps with the targeted management and logical selection of cardiovascular support.
基于生理学的血流动力学不稳定管理已被证明可以指导心血管支持的逻辑选择，并缩短与经验性方法相比的临床恢复时间，因为后者忽略了与血流动力学不稳定相关的机制的异质性。在本报告中，我们根据不同的血压 (BP) 表型、其他临床参数、超声心动图标志物和氧指数，将新生儿血流动力学不稳定、循环休克和代偿程度分为五个生理学类别。这种方法专注于具有正常心脏解剖结构的婴儿的血流动力学不稳定。结论：由于病理生理学的复杂性，血流动力学不稳定的管理具有挑战性；整合不同的监测技术对于了解潜在的病理生理机制以及制定基于生理学的医疗建议和方法至关重要。已知内容：•基于生理学的血流动力学评估可导致针对性和基于病理生理学的医疗建议。新内容：•根据血压表型、全身血管阻力和心肌功能，新生儿血流动力学不稳定可根据潜在机制分为五个主要类别。•新分类有助于有针对性地管理和逻辑选择心血管支持。
