危重儿童动态动脉弹性与液体反应性的关系。

IF 2.7 Q4 Medicine
Critical care explorations Pub Date : 2025-07-14 eCollection Date: 2025-07-01 DOI:10.1097/CCE.0000000000001291
Sarah B Walker, Kyle S Honegger, Michael S Carroll, Debra E Weese-Mayer, Tellen D Bennett, L Nelson Sanchez-Pinto
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引用次数: 0

摘要

目的:心脏机械效率已被证明是成人液体反应性(FR)的预测指标。我们的目的是评估动态动脉弹性(Eadyn)测量的机械效率与平均动脉压(MAP)之间的关系,这些儿童的MAP小于或等于年龄的第50百分位。设计:这是一项回顾性、观察性队列研究。环境/患者:本研究研究了在学术PICU入院前72小时内给予小于或等于18岁的患者大于或等于10ml /kg的静脉注射晶体液体。干预措施:没有。测量方法及主要结果:在给药前20分钟,每隔10秒计算一次Eadyn。FR定义为在给药后20分钟内MAP从给药前到平均MAP增加大于或等于10%。采用Kruskal-Wallis检验评估关联。我们分析了在365次PICU就诊中给予MAP小于或等于年龄第50百分位的儿童490次液体丸。预用药Eadyn与FR无相关性(p < 0.01)。在机械通气或血管活性药物治疗的亚组分析中,以及在MAP百分位数的年龄和MAP百分位数持续时间的分层中,这种相关性仍然存在。此外,大多数儿童的机械效率很高(Eadyn >.7),即使在年龄队列的最低MAP百分位数中也是如此。结论:需要对儿童进行进一步的研究,以了解血压降低时儿童心脏生理的变化,从而制定更有针对性的、基于年龄的休克管理策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association of Dynamic Arterial Elastance With Fluid Responsiveness in Critically Ill Children.

Objectives: Cardiac mechanical efficiency has been shown to be a predictor of fluid responsiveness (FR) in adults. Our goal was to assess the association between mechanical efficiency as measured by dynamic arterial elastance (Eadyn) and mean arterial pressure (MAP) after fluid bolus in children with MAP less than or equal to 50th percentile for age.

Design: This was a retrospective, observational cohort study.

Setting/patients: This studied IV crystalloid fluid boluses of greater than or equal to 10 mL/kg given to patients less than or equal to 18 years old within the first 72 hours of admission to an academic PICU.

Interventions: None.

Measurements and main results: Eadyn was calculated in 10-second intervals during the 20 minutes pre-bolus. FR was defined as an increase of greater than or equal to 10% in MAP from pre-bolus to the average MAP over 20 minutes post-bolus. Kruskal-Wallis test was used to assess associations. We analyzed 490 fluid boluses given to children with MAP less than or equal to 50th percentile for age across 365 PICU encounters. Pre-bolus Eadyn was not associated with FR (p > 0.1). This lack of association persisted in subgroup analysis among those mechanically ventilated or on vasoactive medication, and in stratification by MAP percentile for age and duration of time in MAP percentile. Additionally, mechanical efficiency was high (Eadyn > 0.7) for most children, even in the lowest MAP percentile for age cohorts.

Conclusions: Further research is needed in children to understand the changing cardiac physiology of children as blood pressure decreases to develop more targeted, age-based shock management strategies.

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来源期刊
CiteScore
5.70
自引率
0.00%
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审稿时长
8 weeks
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