Cardiovascular Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference.
Cardiovascular Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference.
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DOI：
10.1542/peds.2021-052888f
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发表时间：
2022-01-01
期刊：
影响因子：
8
通讯作者：
Kissoon, Niranjan
中科院分区：
文献类型：
--
作者：
Alexander, Peta M. A.;Checchia, Paul A.;Ryerson, Lindsay M.;Bohn, Desmond;Eckerle, Michelle;Gaies, Michael;Laussen, Peter;Jeffries, Howard;Thiagarajan, Ravi R.;Shekerdemian, Lara;Bembea, Melania M.;Zimmerman, Jerry J.;Kissoon, Niranjan
心血管功能障碍与危重儿童的不良结局有关。对危重儿童的心血管功能障碍进行循证、共识的定义。计算机检索PubMed和EMBASE数据库，检索时间为1992年1月至2020年1月，使用医学主题词和文本词来定义心血管功能障碍、儿科危重疾病和感兴趣结果的概念。研究包括评估患有心血管功能障碍的危重儿童、筛查心血管功能障碍的评估/评分工具，以及评估与死亡率、功能状态、器官特定结果或其他以患者为中心的结果相关的结果。成人或早产儿(≤36周胎龄)的研究、动物研究、综述/评论、样本量为≤10的病例系列和非英语语言研究被排除在外。不包括有关紫红色先天性心脏病或体外循环术后心血管功能障碍的儿童的研究。从每项符合条件的研究中提取数据到标准数据提取表中，并由工作组成员进行偏差风险评估。心血管功能障碍由9种元素定义，其中4种元素表明存在严重的心血管功能障碍。心肺骤停(>；5分钟)或机械循环支持独立定义严重的心血管功能障碍，而心动过速、低血压、血管活性变力评分、乳酸、肌钙蛋白I、中心静脉血氧饱和度和超声心动图对左心室射血分数的估计都包括在内。专家们对由此产生的定义达成了一致意见(80%)。所有纳入的研究都是观察性的，许多是回溯性的。讲台小组提出了这一循证的心血管功能障碍定义。这篇手稿报告了对心血管功能障碍评分工具的系统回顾，并提出了危重儿童心血管功能障碍的循证标准。
Cardiovascular dysfunction is associated with poor outcomes in critically ill children. To derive an evidence-informed, consensus-based definition of cardiovascular dysfunction in critically ill children. Electronic searches of PubMed and EMBASE were conducted from January 1992 to January 2020, using medical subject heading terms and text words to define concepts of cardiovascular dysfunction, pediatric critical illness, and outcomes of interest. Studies were included if they evaluated critically ill children with cardiovascular dysfunction, assessment/scoring tools to screen for cardiovascular dysfunction, and assessed outcomes related to mortality, functional status, organ-specific outcomes, or other patient-centered outcomes. Studies of adults or premature infants (≤36 weeks gestational age), animal studies, reviews/commentaries, case series with sample size ≤10, and non-English language studies were excluded. Studies of children with cyanotic congenital heart disease or cardiovascular dysfunction after cardiopulmonary bypass were excluded. Data were abstracted from each eligible study into a standard data extraction form along with risk of bias assessment by a task force member. Cardiovascular dysfunction was defined by nine elements, including four which indicate severe cardiovascular dysfunction. Cardiopulmonary arrest (> five minutes) or mechanical circulatory support independently define severe cardiovascular dysfunction, while tachycardia, hypotension, vasoactive-inotropic score, lactate, troponin I, central venous oxygen saturation, and echocardiographic estimation of left ventricular ejection fraction were included in any combination. There was expert agreement (>80%) on the resulting definition. All included studies were observational and many were retrospective. The PODIUM panel propose this evidence-informed definition of cardiovascular dysfunction. This manuscript reports a systematic review on cardiovascular dysfunction scoring tools and proposes evidence-based criteria for cardiovascular dysfunction in critically ill children.