Sorcher Jill L, Kundun Harshannie, Mehta Shivani, Grossestreuer Anne V, Donnino Michael W, Kleinman Monica E, Ross Catherine E
Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine., Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Division of Medical Critical Care, Department of Pediatrics Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
Resusc Plus. 2025 Jun 30;25:101020. doi: 10.1016/j.resplu.2025.101020. eCollection 2025 Sep.
To explore clinical characteristics associated with hemodynamic response to initial dosing of peri-arrest bolus epinephrine (PBE) for acute hypotension in the PICU.
Single center retrospective cohort study of patients < 19 years old who received PBE for acute hypotension in the pediatric intensive care units at our institution from April 2017 to September 2023. Change in systolic blood pressure (SBP) was measured within 5 min before and after PBE. Patients were categorized as non-responders if the change in SBP was ≤ 10 mmHg. The primary analysis used a multivariate logistic regression model to determine factors associated with responder status via manual backward stepwise regression. Post-hoc analyses using Pearson correlation assessed the relationship of age, PBE dose, and SBP and DBP response as continuous variables.
Of the 180 patients analyzed, 121 (67 %) were classified as responders and 59 (33%) as non-responders. In the multivariate analysis, non-responder status was independently associated with presence of invasive mechanical ventilation (aOR 5.00; 95 % CI: 1.33, 20; = 0.017) and acute cardiogenic shock preceding PBE administration (aOR 2.94; 95 % CI:,1.14, 7.69; = 0.025). In the post hoc analyses, change in SBP was significantly correlated with increasing age ( = 0.27, = 0.004), and age was inversely correlated with PBE dose by weight ( = -0.50, < 0.001).
Presence of invasive mechanical ventilation and cardiogenic shock were associated with poor response to PBE. As a continuous variable, SBP response to PBE improved with increasing age despite lower weight-based PBE dosing.
探讨儿科重症监护病房（PICU）中急性低血压患者对初始剂量的心脏骤停周围推注肾上腺素（PBE）的血流动力学反应相关的临床特征。
对2017年4月至2023年9月在我院儿科重症监护病房因急性低血压接受PBE治疗的19岁以下患者进行单中心回顾性队列研究。在PBE给药前后5分钟内测量收缩压（SBP）的变化。如果SBP变化≤10mmHg，则将患者分类为无反应者。主要分析使用多变量逻辑回归模型，通过手动向后逐步回归确定与反应者状态相关的因素。使用Pearson相关性进行事后分析，评估年龄、PBE剂量以及SBP和DBP反应作为连续变量之间的关系。
在分析的180例患者中，121例（67%）被分类为反应者，59例（33%）为无反应者。在多变量分析中，无反应者状态与有创机械通气的存在独立相关（调整后比值比[aOR] 5.00；95%置信区间[CI]：1.33，20；P = 0.017）以及PBE给药前的急性心源性休克独立相关（aOR 2.84；95% CI：1.14，7.69；P = 0.025）。在事后分析中，SBP变化与年龄增加显著相关（r = 0.27，P = 0.004），并且年龄与按体重计算的PBE剂量呈负相关（r = -0.50，P < 0.001）。
有创机械通气和心源性休克的存在与对PBE的反应不佳相关。作为一个连续变量，尽管按体重计算的PBE剂量较低，但随着年龄的增加，SBP对PBE的反应有所改善。
