Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Department of Medicine, Drexel University College of Medicine, Philadelphia, PA.
Crit Care Med. 2024 Sep 1;52(9):1402-1413. doi: 10.1097/CCM.0000000000006339. Epub 2024 Jun 4.
Quantify hypotension burden using high-resolution continuous arterial blood pressure (ABP) data and determine its association with outcome after pediatric cardiac arrest.
Retrospective observational study.
Academic PICU.
Children 18 years old or younger admitted with in-of-hospital or out-of-hospital cardiac arrest who had invasive ABP monitoring during postcardiac arrest care.
None.
High-resolution continuous ABP was analyzed up to 24 hours after the return of circulation (ROC). Hypotension burden was the time-normalized integral area between mean arterial pressure (MAP) and fifth percentile MAP for age. The primary outcome was unfavorable neurologic status (pediatric cerebral performance category ≥ 3 with change from baseline) at hospital discharge. Mann-Whitney U tests compared hypotension burden, duration, and magnitude between favorable and unfavorable patients. Multivariable logistic regression determined the association of unfavorable outcomes with hypotension burden, duration, and magnitude at various percentile thresholds from the 5th through 50th percentile for age. Of 140 patients (median age 53 [interquartile range 11-146] mo, 61% male); 63% had unfavorable outcomes. Monitoring duration was 21 (7-24) hours. Using a MAP threshold at the fifth percentile for age, the median hypotension burden was 0.01 (0-0.11) mm Hg-hours per hour, greater for patients with unfavorable compared with favorable outcomes (0 [0-0.02] vs. 0.02 [0-0.27] mm Hg-hr per hour, p < 0.001). Hypotension duration and magnitude were greater for unfavorable compared with favorable patients (0.03 [0-0.77] vs. 0.71 [0-5.01]%, p = 0.003; and 0.16 [0-1.99] vs. 2 [0-4.02] mm Hg, p = 0.001). On logistic regression, a 1-point increase in hypotension burden below the fifth percentile for age (equivalent to 1 mm Hg-hr of burden per hour of recording) was associated with increased odds of unfavorable outcome (adjusted odds ratio [aOR] 14.8; 95% CI, 1.1-200; p = 0.040). At MAP thresholds of 10th-50th percentiles for age, MAP burden below the threshold was greater in unfavorable compared with favorable patients in a dose-dependent manner.
High-resolution continuous ABP data can be used to quantify hypotension burden after pediatric cardiac arrest. The burden, duration, and magnitude of hypotension are associated with unfavorable neurologic outcomes.
利用高分辨率连续动脉血压（ABP）数据量化低血压负担，并确定其与儿科心脏骤停后结局的关系。
回顾性观察性研究。
学术性儿科重症监护病房。
18 岁或以下的儿童，因院内或院外心脏骤停入院，在心脏骤停后护理期间接受有创 ABP 监测。
无。
在循环恢复后（ROCR）高达 24 小时分析高分辨率连续 ABP。低血压负担是平均动脉压（MAP）和年龄第 5 百分位 MAP 之间时间归一化积分区域。主要结局为出院时神经功能不良（儿科脑功能分类≥3，与基线相比有变化）。Mann-Whitney U 检验比较了有利和不利患者之间的低血压负担、持续时间和幅度。多变量逻辑回归确定了在年龄第 5 至 50 百分位的各种百分位阈值下，不利结局与低血压负担、持续时间和幅度的关系。在 140 名患者中（中位数年龄 53[四分位距 11-146]个月，61%为男性）；63%的患者结局不良。监测持续时间为 21（7-24）小时。使用年龄第 5 百分位的 MAP 阈值，中位低血压负担为 0.01（0-0.11）mmHg-h 每小时，与预后不良的患者相比，低血压负担更大（0[0-0.02]与 0.02[0-0.27]mmHg-hr 每小时，p<0.001）。与预后良好的患者相比，低血压持续时间和幅度更大（0.03[0-0.77]与 0.71[0-5.01]%，p=0.003；0.16[0-1.99]与 2[0-4.02]mmHg，p=0.001）。在逻辑回归中，年龄第 5 百分位以下的每增加 1 点低血压负担（相当于每小时记录时增加 1mmHg-hr 的负担）与不良结局的几率增加相关（调整后的优势比[aOR]14.8；95%置信区间，1.1-200；p=0.040）。在年龄第 10-50 百分位的 MAP 阈值下，MAP 负担在预后不良的患者中低于阈值，呈剂量依赖性。
高分辨率连续 ABP 数据可用于量化儿科心脏骤停后低血压负担。低血压的负担、持续时间和幅度与不良神经结局相关。
