Management of Children in Shock with Cardiac Dysfunction: A Descriptive Study in the Pediatric Intensive Care Unit

Abstract

Introduction

This study analyzes the management of pediatric cardiogenic shock following the recommendations of Brissaud et al. (2016), focusing on epidemiology, clinical practices, mortality rates, and associated risk factors.

Objective

The primary objective of this study was to describe the epidemiology and management practices of patients admitted to pediatric intensive care for cardiogenic or septic shock with cardiac dysfunction. The secondary objective was to assess the mortality rate and identify risk factors associated with mortality.

Methods

This multicenter retrospective study, based on CRH data, includes children (> 5 days and < 18 years old) with septic or cardiogenic shock associated with cardiac dysfunction. Epidemiological, clinical, therapeutic, and biological data, along with results from complementary investigations, were collected. Patients were classified into two groups: “deceased” and “survivors”.

Expected results

Among the 249 children included, the overall mortality rate was 24.9%. The leading cause of cardiac dysfunction was sepsis, with no statistically significant difference between the two groups (p = 0.145). The primary cause of cardiogenic shock was post-cardiac arrest myocardial dysfunction (24.8%), across all etiologies. Dobutamine was the first-line inotropic agent (62.6%) (Figure 1), with no significant difference between groups. Milrinone use was more frequent among survivors (p = 0.036), whereas adrenaline was more commonly administered in the deceased group (p < 0.001). Invasive ventilation was more prevalent in the deceased group (p < 0.001), whereas non-invasive ventilation was more frequent among survivors (p = 0.002). Mortality was associated with a higher PIM3 score, invasive ventilation, neurological distress, adrenaline administration, and renal replacement therapy. A protective trend for milrinone was observed, although not statistically significant.

Perspectives

Management primarily relies on mechanical ventilation and first-line dobutamine administration. This interim analysis highlighted limitations in data collection methods, necessitating adjustments for the next phase of the study, which aims to compare milrinone and dobutamine.