Value of functional echocardiographic parameters in predicting refractory septic shock in neonates

ZHONG Jun-Juan; MO Jing; SHUAI Chun; WANG Yue; ZHANG Jing; MA Dong-Ju; LIN Ying-Yi; YE Xiu-Zhen

doi:10.7499/j.issn.1008-8830.2207077

PDF(635 KB)

Chinese Journal of Contemporary Pediatrics ›› 2022, Vol. 24 ›› Issue (11) : 1213-1218. DOI: 10.7499/j.issn.1008-8830.2207077

CLINICAL RESEARCH

Value of functional echocardiographic parameters in predicting refractory septic shock in neonates

ZHONG Jun-Juan, MO Jing, SHUAI Chun, WANG Yue, ZHANG Jing, MA Dong-Ju, LIN Ying-Yi, YE Xiu-Zhen

Author information +

History +

Abstract

Objective To study the value of functional echocardiographic parameters in predicting refractory septic shock in neonates. Methods A total of 72 neonates with septic shock were enrolled. According to the highest value of septic shock score, they were divided into two groups: refractory (n=30) and non-refractory (n=42). The two groups were compared in terms of clinical data, laboratory findings, and functional echocardiographic parameters. The receiver operating characteristic (ROC) curve was used to evaluate the performance of functional echocardiographic parameters in predicting refractory septic shock. Results Compared with the non-refractory group, the refractory group had significantly lower cardiac output and cardiac index (CI) and a significantly higher mean arterial pressure (MAP)/CI ratio (P<0.05). CI had a cut-off value of 2.6 L/(min·m²), a sensitivity of 79%, a specificity of 83%, and an area under the ROC curve (AUC) of 0.841 in predicting septic shock-related death (P<0.05), and MAP/CI ratio had a cut-off value of 11.4, a sensitivity of 83%, a specificity of 73%, and an AUC of 0.769 (P<0.05). CI had a cut-off value of 2.9 L/(min·m²), a sensitivity of 69%, a specificity of 69%, and an AUC of 0.717 in predicting all-cause death within 28 days (P<0.05). Conclusions CI and MAP/CI ratio can be useful for early prediction of septic shock-related death in neonates.

Key words

Septic shock / Refractory shock / Cardiac index / Mean arterial pressure/cardiac index ratio / Neonate

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

ZHONG Jun-Juan, MO Jing, SHUAI Chun, WANG Yue, ZHANG Jing, MA Dong-Ju, LIN Ying-Yi, YE Xiu-Zhen. Value of functional echocardiographic parameters in predicting refractory septic shock in neonates[J]. Chinese Journal of Contemporary Pediatrics. 2022, 24(11): 1213-1218 https://doi.org/10.7499/j.issn.1008-8830.2207077

References

1 周文浩, 肖甜甜. 新生儿重症医学的数字未来[J]. 中华儿科杂志, 2021, 59(4): 261-263. PMID: 33775042. DOI: 10.3760/cma.j.cn112140-20210127-00079.
2 Jawad I, Luk?i? I, Rafnsson SB. Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality[J]. J Glob Health, 2012, 2(1): 010404. PMID: 23198133. PMCID: PMC3484761. DOI: 10.7189/jogh.02.010404.
3 蒲伟丛, 焦建成, 孟灵芝, 等. 新生儿休克99例病因及死亡危险因素分析[J]. 中华新生儿科杂志, 2021, 36(3): 30-33. DOI: 10.3760/cma.j.issn.2096-2932.2021.03.006.
4 钟隽镌, 张静, 郑璇儿, 等. 血乳酸与血清清蛋白比值对新生儿脓毒性休克的早期预测价值[J]. 中华实用儿科临床杂志, 2019, 34(18): 1386-1389. DOI: 10.3760/cma.j.issn.2095-428X.2019.18.007.
5 袁文浩, 曾凌空, 蔡保欢, 等. 动脉血乳酸对于新生儿休克严重程度和预后判断的价值[J]. 中国当代儿科杂志, 2018, 20(1): 17-20. PMID: 29335076. PMCID: PMC7390323. DOI: 10.7499/j.issn.1008-8830.2018.01.004.
6 McIntosh AM, Tong S, Deakyne SJ, et al. Validation of the Vasoactive-Inotropic Score in pediatric sepsis[J]. Pediatr Crit Care Med, 2017, 18(8): 750-757. PMID: 28486385. PMCID: PMC5548505. DOI: 10.1097/PCC.0000000000001191.
7 Zhong J, Shuai C, Wang Y, et al. Baseline values of left ventricular systolic function in preterm infants with septic shock: a prospective observational study[J]. Front Pediatr, 2022, 10: 839057. PMID: 35425723. PMCID: PMC9001981. DOI: 10.3389/fped.2022.839057.
8 Singh Y, Villaescusa JU, da Cruz EM, et al. Recommendations for hemodynamic monitoring for critically ill children—expert consensus statement issued by the cardiovascular dynamics section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)[J]. Crit Care, 2020, 24(1): 620. PMID: 33092621. PMCID: PMC7579971. DOI: 10.1186/s13054-020-03326-2.
9 Pliauckiene A, Liubsys A, Vankeviciene R, et al. Ultrasonic cardiac output monitor provides effective non-invasive bedside measurements of neonatal cardiac output[J]. J Clin Monit Comput, 2022, 36(3): 803-807. PMID: 33929641. DOI: 10.1007/s10877-021-00711-2.
10 Shostak E, Nahum E, Shochat T, et al. Comparisons of continuous-wave doppler ultrasound monitor and echocardiography in cardiac postoperative pediatric patients[J]. J Intensive Care Med, 2022. Epub ahead of print. PMID: 35503529. DOI: 10.1177/08850666221099830.
11 Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children[J]. Intensive Care Med, 2020, 46(Suppl 1): 10-67. PMID: 32030529. PMCID: PMC7095013. DOI: 10.1007/s00134-019-05878-6.
12 Davis AL, Carcillo JA, Aneja RK, et al. American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock[J]. Crit Care Med, 2017, 45(6): 1061-1093. PMID: 28509730. DOI: 10.1097/CCM.0000000000002425.
13 Morin L, Ray S, Wilson C, et al. Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition[J]. Intensive Care Med, 2016, 42(12): 1948-1957. PMID: 27709263. PMCID: PMC5106490. DOI: 10.1007/s00134-016-4574-2.
14 钟隽镌, 帅春, 王越, 等. 不同休克评分方法对新生儿难治性脓毒性休克预后的评估价值[J]. 中华新生儿科杂志, 2021, 36(6): 28-32. DOI: 10.3760/cma.j.issn.2096-2932.2021.06.006.
15 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019: 729.
16 Ranjit S, Aram G, Kissoon N, et al. Multimodal monitoring for hemodynamic categorization and management of pediatric septic shock: a pilot observational study[J]. Pediatr Crit Care Med, 2014, 15(1): e17-e26. PMID: 24196006. DOI: 10.1097/PCC.0b013e3182a5589c.
17 Ospina-Tascón GA, Teboul JL, Hernandez G, et al. Diastolic shock index and clinical outcomes in patients with septic shock[J]. Ann Intensive Care, 2020, 10(1): 41. PMID: 32296976. PMCID: PMC7160223. DOI: 10.1186/s13613-020-00658-8.
18 Díaz-Gómez JL, Mayo PH, Koenig SJ. Point-of-care ultrasonography[J]. N Engl J Med, 2021, 385(17): 1593-1602. PMID: 34670045. DOI: 10.1056/NEJMra1916062.
19 Sanfilippo F, La Rosa V, Grasso C, et al. Echocardiographic parameters and mortality in pediatric sepsis: a systematic review and meta-analysis[J]. Pediatr Crit Care Med, 2021, 22(3): 251-261. PMID: 33264235. DOI: 10.1097/PCC.0000000000002622.
20 Abdalaziz FA, Algebaly HAF, Ismail RI, et al. The use of bedside echocardiography for measuring cardiac index and systemic vascular resistance in pediatric patients with septic shock[J]. Rev Bras Ter Intensiva, 2018, 30(4): 460-470. PMID: 30672970. PMCID: PMC6334480. DOI: 10.5935/0103-507X.20180067.
21 Singh Y, Katheria A, Tissot C. Functional echocardiography in the neonatal intensive care unit[J]. Indian Pediatr, 2018, 55(5): 417-424. PMID: 29845957.
22 Silversides JA, Fitzgerald E, Manickavasagam US, et al. Deresuscitation of patients with iatrogenic fluid overload is associated with reduced mortality in critical illness[J]. Crit Care Med, 2018, 46(10): 1600-1607. PMID: 29985214. DOI: 10.1097/CCM.0000000000003276.
23 Pawale D, Murki S, Kulkarni D, et al. Echocardiographic assessment of hemodynamic changes in preterm neonates with shock: a prospective pragmatic cohort study[J]. Eur J Pediatr, 2020, 179(12): 1893-1899. PMID: 32794120. DOI: 10.1007/s00431-020-03775-5.