Awadhare Pranali, Patel Radha, McCallin Tracy, Mainali Kiran, Jackson Kelly, Starke Hannah, Bhalala Utpal
The Children's Hospital of San Antonio, San Antonio, TX, United States.
University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, United States.
Front Pediatr. 2022 Apr 7;10:857106. doi: 10.3389/fped.2022.857106. eCollection 2022.
The assessment of fluid responsiveness is important in the management of shock but conventional methods of assessing fluid responsiveness are often inaccurate. Our study aims to evaluate changes in objective hemodynamic parameters as measured using electrical cardiometry (ICON monitor) following the fluid bolus in children presenting with shock and to evaluate whether any specific hemodynamic parameter can best predict fluid responsiveness among children with shock.
We conducted a prospective observational study in children presenting with shock to our emergency department between June 2020 and March 2021. We collected the parameters such as heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and hemodynamic data such as cardiac output CO), cardiac index (CI), index of contractility (ICON), stroke volume (SV), stroke index (SI), corrected flow time (FTC), systolic time ratio (STR), variation of index of contractility (VIC), stroke volume variation (SVV), systemic vascular resistance (SVR), and thoracic fluid content (TFC) using the ICON monitor before and after fluid bolus (FB). We assessed percent change (Δ) and used paired-sample Student's -test to compare pre- and post-hemodynamic data and Mann-Whitney -test to compare fluid responders and non-responders. -Values < 0.05 were considered statistically significant.
We recorded 42 fluid interventions in 40 patients during our study period. The median IQR age was 10.56 (4.8, 14.8) years with male/female ratio (1.2:1). There was a significant decrease in ΔRR [-1.61 (-14.8, 0); = 0.012], ΔDBP [-5.5 (-14.4, 8); = 0.027], ΔMAP [-2.2 (-11, 2); = 0.018], ΔSVR [-5.8 (-20, 5.2); = 0.025], and ΔSTR [-8.39 (-21, 3); = 0.001] and significant increase in ΔTFC [6.2 (3.5, 11.4); = 0.01] following FB. We defined fluid responders by an increase in SV by ≥10% after a single FB of 20 ml/kg crystalloid. Receiver operating curve analysis revealed that among all the parameters, 15% change in ICON had an excellent AUC (0.85) for the fluid responsiveness.
Our study showed significant changes in objective hemodynamic parameters, such as SVR, STR, and TFC following FB in children presenting with shock. A 15% change in ICON had an excellent predictive performance for the fluid responsiveness among our cohort of pediatric shock.
液体反应性评估在休克治疗中很重要，但传统的评估液体反应性的方法往往不准确。我们的研究旨在评估使用心电描记法（ICON监测仪）测量的客观血流动力学参数在休克患儿给予液体冲击后的变化，并评估是否有任何特定的血流动力学参数能够最好地预测休克患儿的液体反应性。
我们于2020年6月至2021年3月在我院急诊科对休克患儿进行了一项前瞻性观察性研究。我们收集了心率（HR）、呼吸频率（RR）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）等参数，以及使用ICON监测仪在液体冲击（FB）前后的心输出量（CO）、心脏指数（CI）、收缩性指数（ICON）、每搏量（SV）、每搏指数（SI）、校正血流时间（FTC）、收缩时间比（STR）、收缩性指数变化（VIC）、每搏量变化（SVV）、全身血管阻力（SVR）和胸腔液体含量（TFC）等血流动力学数据。我们评估了百分比变化（Δ），并使用配对样本t检验比较血流动力学数据前后变化，使用Mann-Whitney U检验比较液体反应者和无反应者。P值<0.05被认为具有统计学意义。
在我们的研究期间，我们记录了40例患者的42次液体干预。年龄中位数（IQR）为10.56（4.8，14.8）岁，男女比例为1.2:1。FB后，ΔRR [-1.61（-14.8，0）；P = 0.012]、ΔDBP [-5.5（-14.4，8）；P = 0.027]、ΔMAP [-2.2（-11，2）；P = 0.018]、ΔSVR [-5.8（-20，5.2）；P = 0.025]和ΔSTR [-8.39（-21，3）；P = 0.001]有显著下降，ΔTFC [6.2（3.5，11.4）；P = 0.01]有显著增加。我们将液体反应者定义为在给予20 ml/kg晶体液单次FB后SV增加≥10%。受试者工作特征曲线分析显示，在所有参数中，ICON变化15%对液体反应性具有出色的曲线下面积（AUC）（0.85）。
我们的研究表明，休克患儿在FB后，SVR、STR和TFC等客观血流动力学参数有显著变化。ICON变化15%在我们的儿科休克队列中对液体反应性具有出色的预测性能。
