Volume : 7, Issue : 1, January - 2018

Functional Echocardiography in critically ill children

Ajit S. Baghela, S. S. Prabhu, Sumitra V

Abstract :

<p>&nbsp;</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align:&#10;justify;line-height:200%;mso-layout-grid-align:none;text-autospace:none"><span style="font-size:12.0pt;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">The purpose of this study was to evaluate the cardiac functions by bedside 2D Echocardiogram/Color Doppler in critically ill children. Design: </span><span style="font-size:12.0pt;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;mso-bidi-language:EN-US">Descriptive, observational, prospective</span><span style="font-size:12.0pt;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"> case control study.<b><i style="mso-bidi-font-style:normal"> </i></b>Setting:<i style="mso-bidi-font-style:normal"> </i>Tertiary care Children&rsquo;s Hospital.<i style="mso-bidi-font-style:normal"> </i></span><span style="font-size:12.0pt;&#10;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:&#10;Arial;mso-bidi-language:EN-US">Methods<b style="mso-bidi-font-weight:normal">: </b>83<b style="mso-bidi-font-weight:normal">/</b></span><span style="font-size:12.0pt;&#10;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-bidi-language:EN-US">100critically ill PICU children who fulfilled the study criteria were included</span><span style="font-size:12.0pt;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;mso-fareast-font-family:Arial;mso-bidi-language:EN-US">. Initial </span><span style="font-size:12.0pt;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;mso-bidi-language:EN-US;mso-bidi-font-weight:bold">Echocardiogram was done within 48 hours of admission and repeat echocardiograms if necessary. </span><span style="font-size:12.0pt;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Cardiac dimensions, functions</span><span style="font-size:12.0pt;line-height:200%;&#10;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-bidi-language:EN-US"> and cardiac output were assessed by standard methods and compared to Pediatric norms for age and Body Surface area (BSA)<b style="mso-bidi-font-weight:normal">. </b>Volume status was assessed by inferior venacaval (IVC) collapsing index (IVC-CI) and IVC distensibility index ( IVC-DI). Results:<b style="mso-bidi-font-weight:&#10;normal"> </b>LV systolic functions were normal in (n=62/83; 74.7%) patients, dysfunction in (n=16/83; 19.27%), hyper contractile in (n=5/83;<span style="mso-spacerun:yes">&nbsp; </span>6.0 %). Left ventricular hypertrophy (LVH) was noted in 22.9% and high LVMI was noted in children with abnormal renal profile, hypertension and hypocalcaemia [p&lt;0.05]</span><span style="font-size:12.0pt;&#10;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">. LV systolic dysfunction was significant in sepsis group patients (32.5%) [p=0.0063] and those who had a PICU stay more than 10 days duration [p=0.013]. Total number of mortality during study period was t</span><span style="font-size:12.0pt;&#10;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-bidi-language:EN-US">en (12%) and transferred out from PICU were 73 patients (87.9%). <span style="color:#1F497D;mso-themecolor:text2;mso-bidi-font-weight:bold;mso-bidi-font-style:&#10;italic"><span style="mso-spacerun:yes">&nbsp;</span></span>Conclusion<b style="mso-bidi-font-weight:normal">: </b>Cardiac dysfunction more prevalent in sepsis group patients and those required prolonged ventilation.<b style="mso-bidi-font-weight:normal"> </b>Evaluation of Cardiac functions and volume status by functional echocardiography </span><span style="font-size:&#10;12.0pt;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">helps to tailor fluids and inotropes timely and support hemodynamics in critically ill children.<o:p></o:p></span></p>