Elevated central venous pressure is associated with increased mortality in pediatric septic shock patients

Abstract

BackgroundCentral venous pressure (CVP) is an important factor affecting capillary blood flow, and it is associated with poor outcomes in adult septic shock patients. However, whether a similar association exists in pediatric patients remains unclear.MethodsWe retrospectively analyzed data from patients admitted to our pediatric intensive care unit (PICU) between February 2009 and July 2015. Patients were divided into two groups—survivors and nonsurvivors—according to 28-day mortality. The associations between (a) mortality and CVP at 6, 24, 48, and 72 h after initiating treatment for established septic shock was analyzed and (b) initial serum lactic acid levels and 6-h CVP.ResultsTwo hundred twenty-six patients were included in this study, and the mortality rate was 29.6% (67 deaths, nonsurvivor group). Initial serum lactic acid levels, Pediatric Risk of Mortality (PRISM) III score, and Vasoactive–Inotropic Score (VIS) within 24 h after PICU admission were significantly higher in the nonsurvivors than in survivors (1.3 [0.9, 2.4] vs. 3.9 [1.6, 8.0] mmol/l, 11.0 [7.0, 15.0] vs. 17.0 [10.0, 21.5], 12.0 [7.0, 25.0] vs. 22.5 [8.0, 55.0], respectively with p-values < 0.001, < 0.001, and 0.009, respectively). In addition, compared to survivors, a greater percentage of nonsurvivors required mechanical ventilation (92.5% vs. 51.6%, p < 0.001) and showed a greater extent of fluid overload at 48 h after admission (3.9% vs. 1.9%, p = 0.006), along with higher 6-h CVP (10.0 [7.0, 16.0] vs. 8.0 [5.0, 11.0] mmHg, p < 0.001). Patient survival according to levels of CVP (CVP < 8 mmHg, CVP 8–12 mmHg, or CVP > 12 mmHg) showed that the CVP > 12-mmHg group had significantly greater mortality rates (50.0%, p = 0.002) than the other groups (21.3% and 27.5%). Furthermore, multivariate analysis identified significant associations of CVP > 12 mmHg, serum lactic acid levels, and the need for mechanical ventilation with mortality (OR: 2.74, 1.30, and 12.51, respectively; 95% CI: 1.11–6.72, 1.12–1.50, and 4.12–37.96, respectively).ConclusionsElevated CVP is an independent risk factor for mortality in pediatric septic shock patients.

Transcranial Doppler Can Predict Development and Outcome of Sepsis-Associated Encephalopathy in Pediatrics With Severe Sepsis or Septic Shock

“…This figure is relatively high when compared with the 10.5 and 24.9% mortality rates reported by the American and multinational studies of Gorgis et al ( 27 ) and Fitzgerald et al ( 28 ), but it is fairly lower than the 50.0% mortality rate reported by the study of Nyirasafari et al ( 29 ) from Rwanda ( 27 – 29 ). However, our mortality rate accords with the Chinese figure of 29.6% ( 30 ). The current study found that PI and RI values were higher in the non-survivor group in comparison with the survivor one.…”

Cardiac output‐guided hemodynamic therapy for adult living donor kidney transplantation in children under 20 kg: A pilot study

“…Studies in adults show that delayed graft function in kidney transplantation is related to postoperative ABP but not to CVP . Moreover, higher CVP levels and fluid overload are associated with higher risks of acute kidney injury, renal replacement therapy, and mortality in critically ill children . In a retrospective analysis, postoperative renal replacement therapy was related to high volumes of intra‐operative fluid administration related to body weight and a higher donor‐recipient weight ratio .…”

“…21 Moreover, higher CVP levels and fluid overload are associated with higher risks of acute kidney injury, renal replacement therapy, and mortality in critically ill children. 22,23 In a retrospective analysis, postoperative renal replacement therapy was related to high volumes of intra-operative fluid administration related to body weight and a higher donor-recipient weight ratio. 5 This supports the idea that CVP-guided fluid administration may lead to tissue edema, especially in small children.…”

Critical Care Management: Sepsis and Disseminated and Local Infections

“…Care should be taken when interpreting central venous pressure, as central venous pressure is related to both intravascular volume and right and left ventricular compliance. Further, children in septic shock with elevated central venous pressure frequently have diastolic dysfunction and left heart strain, which are associated with increased mortality [18][19][20]. Prediction of fluid responsiveness using other hemodynamic variables is an area of active interest, with some data supporting the use of aortic flow velocity and arterial pulse pressure variability with respiration [21,22].…”