Reveco Sonia, Barbagelata Stella, Cruces Pablo, Diaz Franco, Yohanessen Karla, Larraín Marcos, Guerra Mario, Bataszew Alexander
Pediatric Intensive Care Unit, Hospital El Carmen Dr Luis Valentin Ferrada, Santiago, Chile.
Pediatric Intensive Care Unit, Hospital San Juan de Dios, Santiago, Chile.
Front Pediatr. 2025 Jun 3;13:1570519. doi: 10.3389/fped.2025.1570519. eCollection 2025.
This feasibility study aimed to describe the relation between ventricular dysfunction and outcome in pediatric sepsis.
This prospective observational multicenter study was conducted in two Pediatric Intensive Care Units (PICU). We enrolled 51 patients aged younger than 15 year-old diagnosed with sepsis or septic shock. Functional echocardiography was performed by a pediatric intensivist within the first 24 h of admission and blind validated by a pediatric cardiologist. Ventricular dysfunction was defined by the presence of left or right systolic and/or diastolic dysfunction. The absence of these findings was considered normal ventricular function. Outcome was assessed by septic shock diagnosis rate, pediatric adaptation of Sequential Organ Failure Assessment (pSOFA), cardiovascular component of pSOFA, PICU-free and ventilator-free days.
29 patients had sepsis, and 22 had septic shock. The main sites of infection were pulmonary (58.8%) and abdominal (17.6%). One out of four had ventricular dysfunction, and this group presented higher frequency of septic shock (69.2% vs. 34.2%, = 0.028), higher frequency of total pSOFA ≥3 at 24 h (92% vs. 64%, = 0.04), cardiovascular component of pSOFA (69.2% vs. 31.2%, = 0.017), and fewer PICU-free days [18 [0-23] vs. 23 [18-25], = 0.027], compared to normal ventricular function group. Additionally, there were more abnormal tissue doppler measurements, lower ś wave Z-Score [-0.6 [-1.3;0.4] vs. 0.5 [-0.2;1.1], = 0.01] and lower é wave Z-Score [1.5 [-2;0,1] vs. -0.3 [-2;0.4], = 0.03] in the ventricular dysfunction group.
Ventricular dysfunction was associated with more sepsis severity at 24 hours, fewer PICU-free days. Tissue doppler parameters were related to ventricular dysfunction.
本可行性研究旨在描述小儿脓毒症中心室功能障碍与预后之间的关系。
本前瞻性观察性多中心研究在两个儿科重症监护病房（PICU）进行。我们纳入了51名年龄小于15岁、诊断为脓毒症或脓毒性休克的患者。在入院后的头24小时内，由一名儿科重症医生进行功能性超声心动图检查，并由一名儿科心脏病专家进行盲法验证。心室功能障碍定义为存在左或右收缩和/或舒张功能障碍。未发现这些情况被视为心室功能正常。通过脓毒性休克诊断率、小儿序贯器官衰竭评估（pSOFA）、pSOFA的心血管成分、无PICU天数和无呼吸机天数来评估预后。
29例患者患有脓毒症，22例患有脓毒性休克。主要感染部位为肺部（58.8%）和腹部（17.6%）。四分之一的患者存在心室功能障碍，与心室功能正常组相比，该组脓毒性休克的发生率更高（69.2%对34.2%，P = 0.028），24小时时总pSOFA≥3的频率更高（92%对64%，P = 0.04），pSOFA的心血管成分更高（69.2%对31.2%，P = 0.017），无PICU天数更少[18[0 - 23]对vs. 23[18 - 25]，P = 0.027]。此外，心室功能障碍组的组织多普勒测量异常更多，s波Z评分更低[-0.6[-1.3;0.4]对0.5[-0.2;1.1]，P = 0.01]，e波Z评分更低[1.5[-2;0,1]对-0.3[-2;0.4]，P = 0.03]。
心室功能障碍与24小时时更严重的脓毒症、更少的无PICU天数相关。组织多普勒参数与心室功能障碍有关。
