Carotid Doppler Ultrasonography for Hemodynamic Assessment in Critically Ill Children

Abstract Background: Cardiovascular instability is common in critically-ill children. There is scarcity of published high-quality studies to develop meaningful evidence-based hemodynamic monitoring guidelines and hence, with the exception of management of shock, currently there are no published guidelines for hemodynamic monitoring in children. The European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Cardiovascular Dynamics section aimed to provide expert consensus recommendations on hemodynamic monitoring in critically ill children.Methods: Creation of a panel of experts in cardiovascular hemodynamic assessment and hemodynamic monitoring and review of relevant literature - a literature search was performed, and recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. The AGREE statement was followed to prepare this document.Results: Of 100 suggested recommendations across 12 subgroups concerning hemodynamic monitoring in critically ill children, 72 reached “strong agreement”, 20 “weak agreement” and 2 had “no agreement”. Six statements were considered as redundant after rephrasing of statements following first round of voting. The agreed 72 recommendations were then coalesced into 36 detailing four key areas of hemodynamic monitoring in the main manuscript. Due to lack of published evidence to develop evidence-based guidelines, most of the recommendations are based upon expert consensus.Conclusions: These expert consensus-based recommendation may be used to guide clinical practice for hemodynamic monitoring in critically-ill children and they may serve as a basis for highlighting gaps in the knowledge base to guide further research in hemodynamic monitoring.

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Recommendations for hemodynamic monitoring for critically ill children—expert consensus statement issued by the cardiovascular dynamics section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

Critical Care ◽

10.1186/s13054-020-03326-2 ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Yogen Singh ◽

Javier Urbano Villaescusa ◽

Eduardo M. da Cruz ◽

Shane M. Tibby ◽

Gabriella Bottari ◽

...

Keyword(s):

Intensive Care ◽

Critically Ill ◽

Hemodynamic Monitoring ◽

European Society ◽

Neonatal Intensive Care ◽

Expert Consensus ◽

Critically Ill Children ◽

Evidence Based ◽

Cardiovascular Dynamics ◽

Hemodynamic Assessment

Abstract Background Cardiovascular instability is common in critically ill children. There is a scarcity of published high-quality studies to develop meaningful evidence-based hemodynamic monitoring guidelines and hence, with the exception of management of shock, currently there are no published guidelines for hemodynamic monitoring in children. The European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Cardiovascular Dynamics section aimed to provide expert consensus recommendations on hemodynamic monitoring in critically ill children. Methods Creation of a panel of experts in cardiovascular hemodynamic assessment and hemodynamic monitoring and review of relevant literature—a literature search was performed, and recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. The AGREE statement was followed to prepare this document. Results Of 100 suggested recommendations across 12 subgroups concerning hemodynamic monitoring in critically ill children, 72 reached “strong agreement,” 20 “weak agreement,” and 2 had “no agreement.” Six statements were considered as redundant after rephrasing of statements following the first round of voting. The agreed 72 recommendations were then coalesced into 36 detailing four key areas of hemodynamic monitoring in the main manuscript. Due to a lack of published evidence to develop evidence-based guidelines, most of the recommendations are based upon expert consensus. Conclusions These expert consensus-based recommendations may be used to guide clinical practice for hemodynamic monitoring in critically ill children, and they may serve as a basis for highlighting gaps in the knowledge base to guide further research in hemodynamic monitoring.

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Assessment of Hemodynamic Status and Perfusion Markers in Critically Ill Children with Septic Shock

QJM ◽

10.1093/qjmed/hcaa063.003 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

T Abdelgawad ◽

M G Mansour ◽

W M Elguindy ◽

M K Khallaf

Keyword(s):

Septic Shock ◽

Critically Ill ◽

Diagnostic Performance ◽

Myocardial Dysfunction ◽

Critically Ill Children ◽

Military Hospital ◽

Close Monitoring ◽

Hemodynamic Status ◽

Hemodynamic Pattern ◽

Hemodynamic Assessment

Abstract Background Severe sepsis causes release of inflammatory mediators and an associated redistribution of intravascular volume together with depression of myocardial function which manifests as hemodynamic pattern of low cardiac output, low systemic vascular resistance, hypotension, hyperlactatemia and signs of altered tissue perfusion such as oliguria and prolonged capillary refill time. Aim of the Work To assess hemodynamic status together with the perfusion markers (lactate) in critically ill children with septic shock. Patients and Methods This single cohort study was conducted on 40 patients recruited from the pediatric intensive care units (PICU) at: Ain Shams university hospital, Al-Galaa Military medical complex and Ghamra Military hospital From December 2017 to August 2018. Results Only four cases of cases with septic shock developed ejection fraction below 55% denoting myocardial dysfunction during the duration of assessment (first 24 hours of diagnosis). There was negative correlation between cardiac functions represented by hemodynamic measures on one side and SOFA score, PIM 2 score and serum lactate levels on the other side. However, by studying the performance of the parameters included in our study in predicting death; only lactate-24 ≥2.0 (mmoL/L) had statistically significant moderate diagnostic performance, other studied measurements had weak diagnostic performance. Conclusion Myocardial dysfunction was found to be common in children having septic shock. Close monitoring and hemodynamic assessment is important to avoid missing these cases. In addition, serum blood lactate level is an important biomarker that should be carefully monitored as it is a good prognostic tool that can predict outcome in pediatric sepsis and septic shock.

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Recommendations for hemodynamic Monitoring for Critically Ill Children – Expert Consensus Statement issued by the Cardiovascular Dynamics Section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

10.21203/rs.3.rs-53557/v1 ◽

2020 ◽

Author(s):

Yogen Singh ◽

Javier Urbano Villaescusa ◽

Eduardo M. da Cruz ◽

Shane M Tibby ◽

Gabriella Bottari ◽

...

Keyword(s):

Intensive Care ◽

Critically Ill ◽

Hemodynamic Monitoring ◽

European Society ◽

Neonatal Intensive Care ◽

Expert Consensus ◽

Critically Ill Children ◽

Evidence Based ◽

Cardiovascular Dynamics ◽

Hemodynamic Assessment

Abstract Background Cardiovascular instability is common in critically-ill children. There is scarcity of published high-quality studies to develop meaningful evidence-based hemodynamic monitoring guidelines and hence, with the exception of management of shock, currently there are no published guidelines for hemodynamic monitoring in children. The European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Cardiovascular Dynamics section aimed to provide expert consensus recommendations on hemodynamic monitoring in critically ill children. Methods Creation of a panel of experts in cardiovascular hemodynamic assessment and hemodynamic monitoring and review of relevant literature - a literature search was performed, and recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. The AGREE statement was followed to prepare this document. Results Of 100 suggested recommendations across 12 subgroups concerning hemodynamic monitoring in critically ill children, 72 reached “strong agreement”, 20 “weak agreement” and 2 had “no agreement”. Six statements were considered as redundant after rephrasing of statements following first round of voting. Due to lack of published evidence to develop evidence-based guidelines, most of the recommendations are based upon expert consensus. Conclusions These expert consensus-based recommendation may be used to guide clinical practice for hemodynamic monitoring in critically-ill children and they may serve as a basis for highlighting gaps in the knowledge base to guide further research in hemodynamic monitoring.

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Noninvasive Cardiac Output Monitoring Using Electrical Cardiometry and Outcomes in Critically Ill Children

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1718867 ◽

2020 ◽

Author(s):

Lydia Sumbel ◽

Muthiah R. Annamalai ◽

Aanchal Wats ◽

Mohammed Salameh ◽

Arpit Agarwal ◽

...

Keyword(s):

Cardiac Output ◽

Respiratory Failure ◽

Critically Ill ◽

Linear Regression Analysis ◽

Critically Ill Children ◽

Cardiac Output Monitoring ◽

Electrical Cardiometry ◽

Hemodynamic Assessment ◽

Inotrope Score ◽

Output Monitoring

AbstractCardiac output (CO) measurement is an important element of hemodynamic assessment in critically ill children and existing methods are difficult and/or inaccurate. There is insufficient literature regarding CO as measured by noninvasive electrical cardiometry (EC) as a predictor of outcomes in critically ill children. We conducted a retrospective chart review in children <21 years, admitted to our pediatric intensive care unit (PICU) between July 2018 and November 2018 with acute respiratory failure and/or shock and who were monitored with EC (ICON monitor). We collected demographic information, data on CO measurements with EC and with transthoracic echocardiography (TTE), and data on ventilator days, PICU and hospital days, inotrope score, and mortality. We analyzed the data using Chi-square and multiple linear regression analysis. Among 327 recordings of CO as measured by EC in 61 critically ill children, the initial, nadir, and median CO (L/min; median [interquartile range (IQR)]) were 3.4 (1.15, 5.6), 2.39 (0.63, 4.4), and 2.74 (1.03, 5.2), respectively. Low CO as measured with EC did not correlate well with TTE (p = 0.9). Both nadir and mean CO predicted ventilator days (p = 0.05 and 0.01, respectively), and nadir CO was correlated with peak inotrope score (correlation coefficient of –0.3). In our cohort of critically ill children with respiratory failure and/or shock, CO measured with EC did not correlate with TTE. Both nadir and median CO measured with EC predicted outcomes in critically ill children.

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