The use of bedside echocardiography for measuring cardiac index and systemic vascular resistance in pediatric patients with septic shock

Abstract

ObjectiveFollow-up of cardiac index and systemic vascular resistance index by bedside echocardiography until resuscitation.MethodsA set of hemodynamic parameters was obtained, including cardiac output, stroke volume, cardiac index, systemic vascular resistance index, velocity time integral, myocardial performance index, capillary refill time, and heart rate at 0 hours after fluid boluses before the start of inotropes, and followed up after 6 hours and 24 hours.ResultsIncluded were 45 patients with community-acquired septic shock. Septic foci were gastroenteritis (24%), intestinal perforation requiring emergency surgery (24%), pneumonia (20%), central nervous system infection (22%) and soft tissue infection (8%). Klebsiella and Enterobacter were the most frequent isolates. We estimated the factors affecting the cardiac index: high central venous pressure at zero time (r = 0.33, p = 0.024) and persistently high heart rate at hour 6 (r = 0.33, p = 0.03). The systemic vascular resistance index was high in most patients at 0 and 24 hours and at the time of resuscitation and inversely affected the cardiac index as well as affecting the velocity time integral (r = -0.416, -0.61, 0.55 and -0.295). Prolonged capillary refill time was a clinical predictor of the low velocity time integral at 24 hours (r = -0.4). The mortality was 27%. Lower systemic vascular resistance index and higher cardiac output were observed in nonsurviving patients.ConclusionThere was a persistently high systemic vascular resistance index in cold shock patients that influenced the stroke volume index, cardiac index, and velocity time integral. The use of echocardiograms for hemodynamic measurements is important in pediatric septic shock patients to adjust dilators, and vasopressor doses and achieve resuscitation targets in a timely manner.

Successful Treatment of Severely Hypotensive Pediatric Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) with the Guidance of Invasive Hemodynamic Monitoring: A Report of Three Cases

“…More than half of the patients (58%) showed a low CO/high SVR state, and 22% had low CO and low vascular resistance (15). Abdalaziz et al studied 45 patients with community-acquired septic shock by bedside echocardiography and reported that 82% of their cases had the echocardiographic criteria of cold septic shock with low normal or low CI (≤ 3.3 L/m/m 2 ) and normal or high SVRI (≥ 1,600 dyn-sec/cm 5 /m 2 ), whereas the remaining had the echocardiographic criteria of warm septic shock (high CI > 6 L/m/m 2 ) with low normal or low SVRI (≤ 800 dyn-sec/cm 5 /m 2 ) (16). Hydration in the management of septic shock is a doubleedged sword; it can correct relative hypovolemia, which is due to capillary leakage, not taking enough fluids, and fluid losses and maintain organ flow (9); on the other hand, overhydration may cause pulmonary edema or increase mortality (17).…”

Age-Dependent Myocardial Dysfunction in Critically Ill Patients: Role of Mitochondrial Dysfunction

“…Infants and young children with septic shock often present with elevated systemic vascular resistance and low cardiac output in the context of myocardial dysfunction as part of a cold shock phenotype [24,25]. Biventricular dysfunction appears to be common.…”

Association Between Different DVT Prevention Methods and Outcomes of Septic Shock Caused by Intestinal Perforation in China: A Cross-Sectional Study

“…Septic shock is the most common critical illness in intensive care unit (ICU), with long hospital stay, high cost, and high mortality ( 1 – 3 ). Intestinal perforation is one of the important causes of septic shock ( 4 , 5 ). Sepsis leads to complications in coagulation patients ( 6 ).…”