Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/25140
Title: Hemodynamic Response to Fluid Boluses for Hypotension in Children in a Cardiac ICU.
Austin Authors: Gelbart, Ben;Harrois, Anatole;Gardiner, Lauren;Mcgregor, Cherie;Bitker, Laurent;Van Zanten, Eva;Beel, Emma;Bellomo, Rinaldo ;Duke, Trevor;Butt, Warwick
Affiliation: Austin Health
Paediatric Intensive Care Unit, Royal Children's Hospital, University of Melbourne, Department of Paediatrics, Murdoch Children's Research Institute, Parkville, VIC, Australia
Data Analytics Research and Evaluation (DARE) Centre
Intensive Care
Université de Lyon, CREATIS CNRS UMR5220 INSERM U1044 INSA-Lyon, Lyon, France
Department of Intensive Care, Royal Melbourne Hospital, Parkville, VIC, Australia
Department of Anaesthesiology and Critical Care Hopital Bicetre, Assistance Publique-Hopitaux de Paris (AP-HP), Universite Paris Saclav, Gif-sur-Yvette, France
Paediatric Intensive Care Unit, Royal Children's Hospital, Parkville, VIC, Australia
Issue Date: 1-Jan-2021
Date: 2020-10-20
Publication information: Pediatric Critical Care Medicine 2021; 22(1): 79-89
Abstract: To describe the hemodynamic response to fluid boluses for hypotension in children in a cardiac ICU. A prospective, observational study. Single-centered cardiac ICU. Children in a cardiac ICU with hypotension. Clinician prescribed fluid bolus. Sixty-four fluid boluses were administered to 52 children. Fluid composition was 4% albumin in 36/64 (56%), 0.9% saline in 18/64 (28%), and cardiopulmonary bypass pump blood in 10/64 (16%). The median volume and duration were 5.0 mL/kg (interquartile range, 4.8-5.4) and 8 minutes (interquartile range, 4-19), respectively. Hypovolemia/low filling pressures was the most common additional indication (25/102 [25%]). Mean arterial pressure response, defined as a 10% increase from baseline, occurred in 42/64 (66%) of all fluid boluses at a median time of 6 minutes (interquartile range, 4-11). Mean arterial pressure responders had a median peak increase in the mean arterial pressure of 15 mm Hg (43 mm Hg [interquartile range, 29-50 mm Hg] to 58 mm Hg [interquartile range, 49-65 mm Hg]) at 17 minutes (interquartile range, 14-24 min) compared with 4 mm Hg (48 mm Hg [interquartile range, 40-51 mm Hg] to 52 mm Hg [interquartile range, 45-56 mm Hg]) at 10 minutes (interquartile range, 3-18 min) in nonresponders. Dissipation of mean arterial pressure response, when defined as a subsequent decrement in mean arterial pressure below 10%, 5%, and 2% increases from baseline, occurred in 28/42 (67%), 18/42 (43%), and 13/42 (31%) of mean arterial pressure responders, respectively. Cardiopulmonary bypass pump blood was strongly associated with peak change in mean arterial pressure from baseline (coefficient 11.0 [95% CI, 4.3-17.7]; p = 0.02). Fifty out of 64 (78%) were receiving a vasoactive agent. However, change in vasoactive inotrope score was not associated with change in mean arterial pressure (coefficient 2.3 [95% CI, -2.5 to -7.2]; p = 0.35). Timing from admission, nor fluid bolus duration, influenced mean arterial pressure response. In children with hypotension in a cardiac ICU, the median dose and duration of fluid boluses were 5 mL/kg and 8 minutes. Peak response occurred shortly following administration and commonly returned to baseline.
URI: https://ahro.austin.org.au/austinjspui/handle/1/25140
DOI: 10.1097/PCC.0000000000002607
Journal: Pediatric Critical Care Medicine
PubMed URL: 33079893
ISSN: 1529-7535
Type: Journal Article
Appears in Collections:Journal articles

Show full item record

Page view(s)

84
checked on Dec 24, 2024

Google ScholarTM

Check


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.