HEMODYNAMICS CHANGES IN CHILDREN WITH SEPSIS

V.O.  Shadrin; V.V.  Yevtushenko

doi:10.32345/USMYJ.3(103).2017.34-39

V.O. Shadrin Bogomolets National Medical University, Kyiv, Ukraine
V.V. Yevtushenko Bogomolets National Medical University, Kyiv, Ukraine

DOI: https://doi.org/10.32345/USMYJ.3(103).2017.34-39

Keywords: sepsis, shock, hemodynamics, children

Abstract

Sepsis is one of the most common causes of mortality in children. The severe course of sepsis is usually associated with the development of septic shock and multiple organ failure. An important component in the comprehensive examination and evaluation of treatment effectiveness is the monitoring of hemodynamic parameters. We aimed to evaluate changes in central and peripheral hemodynamics by echocardiography and doppler ultrasound in children with sepsis.

Material and methods. A retrospective study of cases of septic shock in children aged 0 to 18 years who underwent treatment in the intensive care unit was conducted. Patients were monitored for central and peripheral hemodynamics by echocardiography and doppler ultrasound.

Results. 108 cases of sepsis were investigated. Meningococcus was an etiological factor in 53,7% patients, 0.9% – Staphylococcus, 0.9% – Pneumococcus, 0,9% – Yersinia, and in 41,7% aetiology was not been established. In 12 children from the study group fatal outcome was occurred. Septic shock development was associated with significantly higher rates of heart rate (HR) and an increase in peripheral resistance (RI) indices in the abdominal trunk and renal arteries. Fatal course of the disease was associated with a high rate of heart rate and a decrease in diastolic velocity (V min) in the abdominal trunk and renal arteries.

Conclusion. Echocardiography and ultrasound dopplerography in children with sepsis are the useful tools to evaluate the pattern and extent of cardiovascular dysfunction.

Results of regional blood flow assessment can be a diagnostic criterion for the septic shock and has prognostic value in children with sepsis.

References

Randolph AG, McCullohRJ. Pediatric sepsis: important considerations for diagnosing and managing severe infections in infants, children, and adolescents. Virulence. 2014;5(l):179-89. doi:10.4161/viru.27045.

Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580-637. doi:10.1097/ CCM.0b013e31827e83af.

Shneider AG, Goodwin MD, Bellomo R. Measurement of kidney perfusion in critically ill patients. Crit Care. 2013;17(2):220. doi: 10.1038/ ajh. 2010.174.

Mccanny P, Bakker J, Vincent J. Haemodynamic monitoring and management. Skills and techniques. Eur Soc Intensive Care Med. 2013. Available at: http://pact.esicm.org/media/HaemMon and Mgt 8 April 2013 flnal.pdf

Goldstein B, Giroir В, Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6(l):2-8. doi: 10.1097/ 01.PCC. 0000149131.72248.E6.

Lopez L, Colan SD, Frommelt PC, et al. Recommendations for Quantification Methods During the Performance of a Pediatric Echocardiogram: A Report From the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr. 2010;23(5):465-495. doi: 10.1016/j.echo.2010.03.019.

Slonim AD, Pollack MM. Pediatric Critical Care Medicine. Lippincott Williams & Wilkins; 2006. Available at: https:// books.google.com.ua/books? id=_XavFllbnSOC.

Cotu CJ, Lerman J, Anderson BJ. A Practice of Anesthesia for

Infants and Children: Expert Consult — Online and Print. Elsevier/ Saunders; 2013. Available at: https://books.google.com.ua/

books? id=MAXTnQStLOcC.

Blanco P, Sasai T. Assessment of left ventricle preload by transthoracic echocardiography: an easy task? J intensive care. 2015;3(l):23. doi:10.1186/s40560-015-0090-7.

Lai WW, Mertens LL, Cohen MS, Geva T, eds. Echocardiography in Pediatric and Congenital Heart Disease. Oxford, UK: Wiley-Blackwell; 2009. doi: 10.1002/9781444306309.

Richardson RR. Atlas of Acquired Cardiovascular Disease Imaging in Children. Springer International Publishing; 2016. Available at: https://books.google.com.ua/books/idMnZCDQAAQBAJ.

Klabunde RE. Cardiovascular physiology concepts. Lippincott Williams & Wilkins/Wolters Kluwer; 2012. Available at: http:// www.cvphysiology.com/textbook. Accessed May 21, 2017.

Davis PJ, Cladis FP. Smith’s Anesthesia for Infants and Children E-Book. Elsevier Health Sciences; 2016. Available at: https:// books.google, com. ua/books ?i d=SGljDQAA QBAJ.

Chavhan GB, Parra DA, Mann A, Navarro OM. Normal Doppler spectral waveforms of major pediatric vessels: specific patterns. Radiographics. 2008;28(3):691-706. doi: 10.1148/rg.283075095.

Hamborsky J, Kroger A, Wolfe S, Eds. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine- Preventable Diseases. 13th ed. Washington D.C. Public Health Foundation; 2015. Available at: https://www.cdc.gov/vaccines/pubs/ pinkbook/front-matter. html.

HuangM-Y, Chen C-Y, Chien J-H, et al. Serum Procalcitonin and Procalcitonin Clearance as a Prognostic Biomarker in Patients with Severe Sepsis and Septic Shock. Biomed Res Int. 2016;2016:1758501. doi: 10.1155/2016/1758501.

Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40(12): 1 795-815. doi: 10.1007/s00134-014-3525-z.

Aneja RK, Carcillo JA. Differences between adult and pediatric septic shock. Minerva Anestesiol. 2011;77(10):986-92. Available at: http:/ /www.ncbi.nlm.nih.gov/pubmed/21952599. Accessed July 31, 2017.

Brierley, JoeMD; Carcillo, Joseph A. MD; Choong, Karen MD; Cornell, Tim MD; DeCaen AM. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009;37(2):666-688. Available at: http://journals.lww.com/ccmjournal/ Abstract/2009/02000/Clinical_practiceparameter s_for_hemodynamic. 39.aspx. Accessed March 28, 2012.

Bonanno FG. Clinical pathology of the shock syndromes. J Emerg Trauma Shock. 2011;4(2):233-43. doi:10.4103/0974-2700.82211.

Hiltebrand LB, Krejci V, Banic A, Erni D, Wheatley AM, Sigurdsson GH. Dynamic study of the distribution of microcirculatory blood flow in multiple splanchnic organs in septic shock. Crit Care Med. 2000;28(9):3233-41. Available at: http://www.ncbi.nlm.nih.gov/pubmed/ 11008987. Accessed June 12, 2017.

Krejci V, Hiltebrand L, Banic A, Erni D, Wheatley AM, Sigurdsson GH. Continuous measurements of microcirculatory blood flow in gastrointestinal organs during acute haemorrhage. Br J Anaesth. 2000;84(4):468-75. Available at: http://www.ncbi.nlm.nih.gov/pubmed/ 10823098. Accessed July 31, 2017.