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Article Abstract
Objectives: Cardiac mechanical efficiency has been shown to be a predictor of fluid responsiveness (FR) in adults. Our goal was to assess the association between mechanical efficiency as measured by dynamic arterial elastance (Eadyn) and mean arterial pressure (MAP) after fluid bolus in children with MAP less than or equal to 50th percentile for age.
Design: This was a retrospective, observational cohort study.
Setting/patients: This studied IV crystalloid fluid boluses of greater than or equal to 10 mL/kg given to patients less than or equal to 18 years old within the first 72 hours of admission to an academic PICU.
Interventions: None.
Measurements And Main Results: Eadyn was calculated in 10-second intervals during the 20 minutes pre-bolus. FR was defined as an increase of greater than or equal to 10% in MAP from pre-bolus to the average MAP over 20 minutes post-bolus. Kruskal-Wallis test was used to assess associations. We analyzed 490 fluid boluses given to children with MAP less than or equal to 50th percentile for age across 365 PICU encounters. Pre-bolus Eadyn was not associated with FR (p > 0.1). This lack of association persisted in subgroup analysis among those mechanically ventilated or on vasoactive medication, and in stratification by MAP percentile for age and duration of time in MAP percentile. Additionally, mechanical efficiency was high (Eadyn > 0.7) for most children, even in the lowest MAP percentile for age cohorts.
Conclusions: Further research is needed in children to understand the changing cardiac physiology of children as blood pressure decreases to develop more targeted, age-based shock management strategies.
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