ABSTRACT
OBJECTIVES: The hemodynamic profile of multisystem inflammatory syndrome in children (MIS-C)-related shock remains poorly defined and, therefore, challenging to support with pharmacotherapy in the ICU. We aimed to evaluate the hemodynamic profile and vasoactive medication management used in MIS-C patients presenting to the ICU in shock and provide data from high-fidelity continuous cardiac output monitoring. DESIGN: Single-center retrospective case-cohort study. SETTING: Pediatric and cardiac ICU in a quaternary-care hospital. PATIENTS: All patients who met U.S. Centers for Disease Control and Prevention criteria for MIS-C and who were admitted to the ICU between March 2020 and May 2021 required vasoactive support and were placed on continuous cardiac index (CCI) monitoring. Patients requiring extracorporeal life support were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 52 children with MIS-C presenting in shock and requiring vasoactive support, 14 patients (27%) were placed on CCI monitoring. These 14 patients had hyperdynamic cardiac index (CI) and low indexed systemic vascular resistance (SVRi) in the first 24 hours with normalization of CI and improved SVRi within the subsequent 24 hours. CONCLUSIONS: Further studies are needed to evaluate the difference between the use of vasoconstrictor versus vasodilators in pediatric patients with MIS-C because a phenotype with high CI and low SVRi may be important.
Subject(s)
COVID-19 , Shock , Adolescent , COVID-19/complications , Child , Cohort Studies , Hemodynamics , Humans , Retrospective Studies , Shock/etiology , Systemic Inflammatory Response SyndromeSubject(s)
Echocardiography/methods , Heart Transplantation/adverse effects , Myocardial Contraction , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Function, Left , Adolescent , Age Factors , Allografts , Biomechanical Phenomena , Child , Female , Heart Transplantation/mortality , Humans , Male , Predictive Value of Tests , Prospective Studies , Risk Factors , Stroke Volume , Treatment Outcome , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/mortality , Ventricular Dysfunction, Left/physiopathologyABSTRACT
SETTING: In adults with cardiomyopathy, tissue Doppler imaging (TDI) has been shown to correlate with left ventricular filling pressures (LVFPs) and has been advocated as a surrogate to catheterization. However, this has not been validated in children. DESIGN: This is a retrospective review of children ≤18 years old with dilated, hypertrophic, restrictive, and left ventricular noncompaction cardiomyopathy who underwent cardiac catheterization within 3 months of an echocardiogram. Spearman's correlation coefficients were calculated to assess a correlation between LVFP and mitral inflow E/A ratio, lateral mitral E/E', and septal E/E'. RESULTS: Thirty-eight patients were included in the study; median age was 8.6 years old. The median LVFP was 19 mm Hg, median mean pulmonary artery pressure was 25 mm Hg, and median pulmonary vascular resistance index (PVRi) was 2.4 Wu. There was no significant correlation between LVFP or PVRi with lateral mitral E/E' or septal E/E'. There was a positive correlation between LVFP and mitral inflow E/A ratio (rs = 0.59, P < .01). In a subgroup analysis of patients with hypertrophic or restrictive cardiomyopathy, there was a negative correlation (rs = 0.56, P = .02) between the mean pulmonary artery pressure and septal A'. CONCLUSIONS: TDI measures of diastolic function are not reliable surrogates for LVFP, mean pulmonary artery pressures, and PVRi at catheterization in children.
