Ip PYF, Periasamy U, Staffa SJ, Zurakowski D, Kantor DB. Management Changes After Echocardiography Are Associated With Improved Outcomes in Critically Ill Children.
Pediatr Crit Care Med 2024;
25:689-698. [PMID:
38591948 DOI:
10.1097/pcc.0000000000003513]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
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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