重症儿童接受超声心动图检查后的管理改变与预后改善有关。

IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE
Pediatric Critical Care Medicine Pub Date : 2024-08-01 Epub Date: 2024-04-09 DOI:10.1097/PCC.0000000000003513
Pui Yin Florence Ip, Uvaraj Periasamy, Steven J Staffa, David Zurakowski, David B Kantor
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引用次数: 0

摘要

目的评估重症儿童在接受正规超声心动图检查后的管理变化和治疗效果:设计:2011 年 1 月 1 日至 2020 年 12 月 31 日期间的回顾性队列研究:地点:三级儿童医院:患者:1 至 18 岁,在入住重症监护室 72 小时内接受过正规超声心动图检查,且在研究时插管和输注血管活性药物。患者被分为两个心功能组:1)心功能接近正常组;2)心功能减退组:方法:从电子病历中抽取临床变量,并按时间顺序排列与超声心动图检查相对应的变量。超声心动图检查前的血管活性和液体管理策略与组织灌注和容量超负荷的指标相关。超声心动图检查后的管理变化具有特征性并与结果相关:测量和主要结果在最终发现心功能减退的患者中,使用血管收缩剂与乳酸清除率和氧萃取率降低有关。在这组患者中,血管收缩剂的使用还与更宽松的液体管理策略、肺水分增加的证据以及更差的Spo2/Fio2有关。超声心动图显示心功能减退的患者很可能会改变管理策略,转而使用肌注药物和更保守的输液管理。与仍在使用血管收缩剂的患者相比,心功能减退的患者改用肌注药物后更有可能拔管和脱离血管活性支持:结论:在心功能减退的患者中,超声心动图检查后管理策略的改变与重症监护干预时间的缩短有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Management Changes After Echocardiography Are Associated With Improved Outcomes in Critically Ill Children.

Objectives: To evaluate management changes and outcomes in critically ill children after formal echocardiography.

Design: Retrospective cohort study between January 1, 2011, and December 31, 2020.

Setting: Tertiary care children's hospital.

Patients: Patients from 1 to 18 years who had formal echocardiography within 72 hours of ICU admission and who were intubated and on vasoactive infusions at the time of the study. Patients were stratified into two cardiac function groups: 1) near-normal cardiac function and 2) depressed cardiac function.

Methods: Clinical variables were abstracted from the electronic medical record and placed in time sequence relative to echocardiography. Vasoactive and fluid management strategies in place before echocardiography were associated with markers of tissue perfusion and volume overload. Management changes after echocardiography were characterized and associated with outcomes.

Interventions: None.

Measurements and main results: Among patients eventually found to have depressed cardiac function, the use of vasoconstrictors was associated with worse lactate clearance and oxygen extraction ratio. Use of vasoconstrictors in this cohort was also associated with a more liberal fluid management strategy, evidence of increased lung water, and a worse Sp o2 /F io2 . An echocardiogram demonstrated depressed cardiac function was likely to be followed by management changes that favored inotropes and more conservative fluid administration. Patients with depressed cardiac function who were switched to inotropes were more likely to be extubated and to wean off vasoactive support compared with those patients who remained on vasoconstrictors.

Conclusions: Among patients with depressed cardiac function, alterations in management strategy after echocardiography are associated with shortened duration of intensive care interventions.

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来源期刊
Pediatric Critical Care Medicine
Pediatric Critical Care Medicine 医学-危重病医学
CiteScore
7.40
自引率
14.60%
发文量
991
审稿时长
3-8 weeks
期刊介绍: Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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