危重症患儿心功能障碍标准：PODIUM 共识会议。

Cardiovascular Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference.

机构信息

Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.

Departments of Pediatrics.

出版信息

Pediatrics. 2022 Jan 1;149(1 Suppl 1):S39-S47. doi: 10.1542/peds.2021-052888F.

DOI:10.1542/peds.2021-052888F

PMID:34970677

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9745438/

Abstract

CONTEXT

Cardiovascular dysfunction is associated with poor outcomes in critically ill children.

OBJECTIVE

We aim to derive an evidence-informed, consensus-based definition of cardiovascular dysfunction in critically ill children.

DATA SOURCES

Electronic searches of PubMed and Embase were conducted from January 1992 to January 2020 using medical subject heading terms and text words to define concepts of cardiovascular dysfunction, pediatric critical illness, and outcomes of interest.

STUDY SELECTION

Studies were included if they evaluated critically ill children with cardiovascular dysfunction and assessment and/or scoring tools to screen for cardiovascular dysfunction and assessed mortality, functional status, organ-specific, or other patient-centered outcomes. Studies of adults, premature infants (≤36 weeks gestational age), animals, reviews and/or commentaries, case series (sample size ≤10), and non-English-language studies were excluded. Studies of children with cyanotic congenital heart disease or cardiovascular dysfunction after cardiopulmonary bypass were excluded.

DATA EXTRACTION

Data were abstracted from each eligible study into a standard data extraction form, along with risk-of-bias assessment by a task force member.

RESULTS

Cardiovascular dysfunction was defined by 9 elements, including 4 which indicate severe cardiovascular dysfunction. Cardiopulmonary arrest (>5 minutes) or mechanical circulatory support independently define severe cardiovascular dysfunction, whereas tachycardia, hypotension, vasoactive-inotropic score, lactate, troponin I, central venous oxygen saturation, and echocardiographic estimation of left ventricular ejection fraction were included in any combination. There was expert agreement (>80%) on the definition.

LIMITATIONS

All included studies were observational and many were retrospective.

CONCLUSIONS

The Pediatric Organ Dysfunction Information Update Mandate panel propose this evidence-informed definition of cardiovascular dysfunction.

摘要

背景

心血管功能障碍与危重症患儿的不良预后相关。

目的

我们旨在制定一个基于循证和共识的危重症患儿心血管功能障碍定义。

资料来源

通过医学主题词和文本词对 PubMed 和 Embase 进行电子检索，检索时间从 1992 年 1 月至 2020 年 1 月，以定义心血管功能障碍、儿科危重症和感兴趣的结局的概念。

研究选择

如果研究评估了患有心血管功能障碍的危重症儿童，并且有用于筛查心血管功能障碍的评估和/或评分工具，并评估了死亡率、功能状态、器官特异性或其他以患者为中心的结局，则纳入研究。排除成人、早产儿（≤36 周胎龄）、动物、综述和/或评论、病例系列（样本量≤10）和非英语语言研究。排除患有发绀性先天性心脏病或体外循环后心血管功能障碍的儿童的研究。

资料提取

从每项合格研究中提取数据，并将数据纳入标准数据提取表中，同时由任务组成员对风险偏倚进行评估。

结果

心血管功能障碍由 9 个要素定义，其中 4 个要素表示严重的心血管功能障碍。心肺骤停（>5 分钟）或机械循环支持独立定义严重的心血管功能障碍，而心动过速、低血压、血管活性正性肌力评分、乳酸、肌钙蛋白 I、中心静脉血氧饱和度和左心室射血分数的超声心动图估计值可任意组合。定义得到了专家的广泛认可（>80%）。