Hemodynamic Response to Fluid Boluses for Hypotension in Children in a Cardiac ICU

被引:6
作者
Gelbart, Ben [1 ]
Harrois, Anatole [2 ,3 ]
Gardiner, Lauren [4 ]
Mcgregor, Cherie [5 ]
Bitker, Laurent [6 ,7 ]
Van Zanten, Eva [5 ]
Beel, Emma [5 ]
Bellomo, Rinaldo [8 ,9 ]
Duke, Trevor [1 ]
Butt, Warwick [1 ]
机构
[1] Univ Melbourne, Royal Childrens Hosp, Murdoch Childrens Res Inst, Paediat Intens Care Unit,Dept Paediat, Parkville, Vic, Australia
[2] Royal Melbourne Hosp, Dept Intens Care, Parkville, Vic, Australia
[3] Univ Paris Saclay, Hop Bicetre, AP HP, Dept Anaesthesiol & Crit Care, Gif Sur Yvette, France
[4] Royal Childrens Hosp, Murdoch Childrens Res Inst, Paediat Intens Care Unit, Parkville, Vic, Australia
[5] Royal Childrens Hosp, Paediat Intens Care Unit, Parkville, Vic, Australia
[6] Austin Hlth, Dept Intens Care, Heidelberg, Vic, Australia
[7] Univ Lyon, CREATIS CNRS UMR5220, INSERM U1044, INSA Lyon, Lyon, France
[8] Univ Melbourne, Data Analyt Res & Evaluat DARE Ctr, Parkville, Vic, Australia
[9] Austin Hosp, Heidelberg, Vic, Australia
关键词
albumins; blood pressure; hemodynamics; child; fluid therapy; thoracic surgery;
D O I
10.1097/PCC.0000000000002607
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objectives: To describe the hemodynamic response to fluid boluses for hypotension in children in a cardiac ICU. Design: A prospective, observational study. Setting: Single-centered cardiac ICU. Patients: Children in a cardiac ICU with hypotension. Interventions: Clinician prescribed fluid bolus. Measurements and Main Results: Sixty-four fluid boluses were administered to 52 children. Fluid composition was 4% albumin in 36/64 (56%), 0.9% saline in 18/64 (28%), and cardiopulmonary bypass pump blood in 10/64 (16%). The median volume and duration were 5.0 mL/kg (interquartile range, 4.8-5.4) and 8 minutes (interquartile range, 4-19), respectively. Hypovolemia/low filling pressures was the most common additional indication (25/102 [25%]). Mean arterial pressure response, defined as a 10% increase from baseline, occurred in 42/64 (66%) of all fluid boluses at a median time of 6 minutes (interquartile range, 4-11). Mean arterial pressure responders had a median peak increase in the mean arterial pressure of 15 mm Hg (43 mm Hg [interquartile range, 29-50 mm Hg] to 58 mm Hg [interquartile range, 49-65 mm Hg]) at 17 minutes (interquartile range, 14-24 min) compared with 4 mm Hg (48 mm Hg [interquartile range, 40-51 mm Hg] to 52 mm Hg [interquartile range, 45-56 mm Hg]) at 10 minutes (interquartile range, 3-18 min) in nonresponders. Dissipation of mean arterial pressure response, when defined as a subsequent decrement in mean arterial pressure below 10%, 5%, and 2% increases from baseline, occurred in 28/42 (67%), 18/42 (43%), and 13/42 (31%) of mean arterial pressure responders, respectively. Cardiopulmonary bypass pump blood was strongly associated with peak change in mean arterial pressure from baseline (coefficient 11.0 [95% CI, 4.3-17.7]; p = 0.02). Fifty out of 64 (78%) were receiving a vasoactive agent. However, change in vasoactive inotrope score was not associated with change in mean arterial pressure (coefficient 2.3 [95% CI, -2.5 to -7.2]; p = 0.35). Timing from admission, nor fluid bolus duration, influenced mean arterial pressure response. Conclusions: In children with hypotension in a cardiac ICU, the median dose and duration of fluid boluses were 5 mL/kg and 8 minutes. Peak response occurred shortly following administration and commonly returned to baseline.
引用
收藏
页码:79 / 89
页数:11
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