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PO-0042 Prevalence And Outcome Of Diastolic Dysfunction In Children With Fluid Refractory Septic Shock – A Prospective Observational Study
  1. J Sankar,
  2. A Jain,
  3. S Dewangan,
  4. N Dubey,
  5. R Das
  1. Pediatrics, Pgimer Dr Rml Hospital, New Delhi, India

Abstract

Background and aims Severe sepsis is often characterised by disturbances in cardiac function, popularly known as sepsis induced myocardial dysfunction (SIMD). SIMD may be systolic (SD), diastolic (DD) or global. Diastolic dysfunction has been infrequently reported in only a few studies on adult patients till date. Detecting DD early in the course has important therapeutic and prognostic implications in the management of septic shock. Our aim was therefore, to determine the prevalence and outcome of DD in children with septic shock and to generate evidence for possible early clinical predictors of DD in such patients.

Methods Consecutive children ≤17 years of age with fluid refractory septic shock and not on mechanical ventilation admitted to our ICU from June 2011 to August 2012 were included. DD was defined as an abnormal ‘E’, mitral annulus velocity on tissue Doppler imaging at admission.

Results A total of 56 children were included. The prevalence of DD was 41.1% (95% CI: 27.8 to 54.4) and the mortality rate was 43% in those with DD. On univariable analysis of possible early predictors of DD, we observed that children with DD tended to have higher mean CVP (13 vs. 6; p < 0.0001) and greater positivity for cTnT (70% vs. 36%, p = 0.01) as compared to others. On multivariable analysis, only an increased CVP remained significant (adjOR: 1.6; 95% CI: 1.12, 2.14, p = 0.008).

Conclusion Diastolic dysfunction is common in children with fluid refractory septic shock and immediate outcome may be poorer in such patients. Increased CVP after initial fluid resuscitation may be an early indicator of DD and warrant urgent bedside echocardiography.

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