Myocardial Dysfunction in Pediatric Septic Shock

• Published in: The Journal of pediatrics Vol. 164; no. 1; pp. 72 - 77.e2
• Main Authors: Raj, Shashi, MD, Killinger, James S., MD, Gonzalez, Jennifer A., RDCS, Lopez, Leo, MD, FASE
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 2014
• Subjects: Child; Child, Preschool; Diastole; Echocardiography, Doppler; Female; Follow-Up Studies; Humans; Incidence; Infant; Length of Stay - trends; Male; Myocardial Contraction; Pediatrics; Prospective Studies; Shock, Septic - complications; Shock, Septic - mortality; Survival Rate - trends; Systole; United States - epidemiology; Ventricular Dysfunction, Left - epidemiology; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology; United States; PCCU; A; Mitral valve annular velocity during systole; RV; TTE; E; Left ventricular; MPI; LV; PELOD; Mitral valve annular velocity in early diastole; Mitral valve annular velocity in late diastole; ś; Pediatric Logistic Organ Dysfunction; Pediatric critical care unit; á; EF; Transthoracic echocardiography; é; Myocardial performance index; Pediatric Risk, Injury, Failure, Loss, and End-Stage Kidney Disease; Mitral valve inflow velocity in late diastole; Mitral valve inflow velocity in early diastole; Mitral valve annular acceleration during isovolumic contraction; IVA; Right ventricular; pRIFLE; Ejection fraction
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2013.09.027

Objective To evaluate the prevalence and significance of myocardial dysfunction in children with septic shock. Study design Thirty patients with septic shock were evaluated by transthoracic echocardiography within 24 hours of admission to a pediatric critical care unit. Transthoracic echocardiography evaluation included left ventricular (LV) size and function, mitral valve inflow velocities in early and late diastole, mitral valve annular velocities in systole and early and late diastole, and LV myocardial performance index. LV systolic dysfunction was defined as an ejection fraction or shortening fraction z -score <−2, and LV diastolic dysfunction was defined as a mitral valve inflow velocity/annular velocity in early diastole ratio z -score >2. Secondary outcomes included troponin I concentration, acute kidney injury, and 28-day mechanical ventilation–free duration. Results Mortality for the 30 patients (mean age, 9.5 ± 7 years) was 7%. The prevalence of LV systolic and/or diastolic dysfunction was 53% (16 of 30). Eleven patients (37%) had systolic dysfunction, 10 (33%) had diastolic dysfunction, and 5 (17%) had both. Systolic and/or diastolic dysfunction was significantly associated with troponin I level ( P = .007) and acute kidney injury ( P = .02), but not with ventilation-free duration ( P = .12). Kaplan-Meier analyses for pediatric critical care unit and hospital length of stay identified no differences between patients with and those without myocardial dysfunction. Conclusion Myocardial dysfunction occurs frequently in children with septic shock but might not affect hospital length of stay.