Andrew Becker, MD,
Pediatric Critical Care Fellow
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Sarah Ginsburg, MD
Assistant Professor
UT Southwestern Medical Center, United States
Disclosure information not submitted.
Mark Weber, RN, CRNP-AC, FCCM
Critical Care Nurse Practitioner
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Darshana Parikh, BA
Research Assistant
Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
Samuel Rosenblatt, MD (he/him/his)
Childrens Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Adam Himebauch, MD
Assistant Professor of Anesthesiology and Critical Care Medicine
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Christie Glau, MD
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Garrett Keim, MD (he/him/his)
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Akira Nishisaki, MD, MSCE
Associate Professor of Anesthesia and Critical Care Medicine
The Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
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Thomas Conlon, MD
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Title: Left Ventricular Diastolic Dysfunction in Pediatric Sepsis - A Prospective Study
Introduction: Left ventricular diastolic dysfunction (LVDD) is associated with difficulty in ventilator weaning, longer mechanical ventilation, and increased mortality in adults with sepsis. However, the consequences of LVDD in pediatric sepsis are not well characterized. We prospectively evaluated the presence of LVDD in pediatric sepsis patients. We hypothesized the presence of LVDD was associated with respiratory failure (primary outcome), mechanical ventilation (MV), non-invasive positive pressure ventilation (NIPPV), vasopressor/inotrope requirement, PICU and hospital LOS, and mortality (secondary outcomes).
Methods: This is an interim analysis of a prospective study of pediatric patients with severe sepsis or septic shock admitted to a quaternary non-cardiac PICU from 1/2018-7/2021. Point-of-care cardiac ultrasound images were obtained within 36 hours of sepsis and assessed for mitral inflow velocity (E), atrial velocity (A), early mitral annular motion septal and lateral velocity (e’) and qualitative function. LVDD was defined as either E/e’ >10 or an E/A < 0.8 or >1.5. Respiratory failure was defined as PaO2:FiO2 (P:F) ratio < 300 or SpO2:FiO2 (S:F) ratio < 264 at time of ultrasound. Fisher’s Exact and Wilcoxon rank-sum tests were utilized to compare patients with and without LVDD.
Results: 37 patients (median 8.3 years, 51% male) were enrolled. 25 (68%) patients met LVDD criteria. There was no difference in admission risk of mortality between patients with and without LVDD (PIM2 %ROM median 4.1, IQR [1.3-5.3] vs 4.4 [1.3-5.3]; p=0.73). LVDD was not associated with respiratory failure (12% with LVDD vs 33% without LVDD; p=0.16), requirement of MV (64% vs 58%; p=1), NIPPV (20% vs 8%; p=0.64), or vasopressor/inotrope (84% vs 92%; p=0.65). LVDD was not associated with PICU LOS (4.7 [2.9-6.9] vs 4.4 [3.1-9.1] days; p=0.96), hospital LOS (9.7 [4.9-13.7] vs 9.7 [5.4-13.58] days; p=0.93), or mortality (0% vs 0%; p=1).
Conclusions: Point-of-care evaluation of diastolic dysfunction in pediatrics is feasible. This interim analysis did not show an association of LVDD in sepsis with early respiratory failure, MV, NIPPV, or vasopressor/inotrope requirement, nor with PICU LOS, hospital LOS, or mortality. We have not reached adequate power to draw definitive conclusions.