Faculty of Medicine of University of Porto, Porto, Portugal; Pediatric Intensive Care Unit, Centro Hospitalar Universitário de São João, Porto, Portugal.
Faculty of Medicine of University of Porto, Porto, Portugal.
Int J Cardiol. 2023 Sep 15;387:131132. doi: 10.1016/j.ijcard.2023.131132. Epub 2023 Jun 22.
Brain injury is a leading cause of morbidity and mortality in the pediatric population. Neurogenic stunned cardiomyopathy is a complication associated with several neurological conditions that can lead to worse outcomes. It presents as alterations in blood pressure, cardiac rhythm disturbances and the increase in cardiac injury biomarkers. This systematic review aims to assess the hemodynamic consequences of brain injury in the pediatric population to identify better management strategies and improve outcomes.
An electronic literature search was performed in Pubmed, Scopus and WebOfScience, up until October 3rd, 2022. The selected articles underwent quality assessment using the National Heart, Lung and Blood Institute tools for cohort and case-control studies.
This systematic review includes thirteen articles on the effects of brain injury in arterial pressure, rhythm disturbances and biomarkers of myocardial injury. These studies showed the following key results: both hypotension and hypertension are associated with worse outcomes; brain injury could be related to longer QTc intervals; neurogenic stunned cardiomyopathy was a common found after brain injury.
This is the first systematic review to report cardiovascular abnormalities arising from brain injury in children. An early arterial pressure, electrocardiographic and echocardiographic evaluation, as well as the measure of serum biomarkers for myocardial injury, can be critical in identifying poor prognostic factors. Further research is required to understand the implications of our findings in clinical practice.
脑损伤是儿科人群发病率和死亡率的主要原因。神经源性休克性心肌病是与几种神经系统疾病相关的并发症，可导致更差的结局。其表现为血压改变、心律失常和心肌损伤生物标志物增加。本系统评价旨在评估脑损伤对儿科人群的血液动力学后果，以确定更好的管理策略并改善结局。
截至 2022 年 10 月 3 日，在 Pubmed、Scopus 和 WebOfScience 上进行了电子文献检索。使用美国国立心肺血液研究所（National Heart, Lung and Blood Institute）针对队列和病例对照研究的工具对选定的文章进行了质量评估。
本系统评价包括 13 篇关于脑损伤对动脉压、节律紊乱和心肌损伤生物标志物影响的文章。这些研究显示了以下关键结果：低血压和高血压均与不良结局相关；脑损伤可能与更长的 QTc 间隔有关；神经源性休克性心肌病是脑损伤后常见的发现。
这是第一份报告儿童脑损伤引起的心血管异常的系统评价。早期的动脉压、心电图和超声心动图评估以及心肌损伤血清生物标志物的测量，对于识别不良预后因素至关重要。需要进一步的研究来了解我们的研究结果在临床实践中的意义。
