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Cardiac function in pediatric septic shock survivors
Hendrika Knoester1, Jeanine J Sol, Pascal Ramsodit
1Pediatric Intensive Care Unit, Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. h.knoester@amc.uva.nl
Insights
Most pediatric septic shock survivors show excellent cardiac recovery. However, some experience rhythm disturbances and reduced ventricular function, necessitating long-term cardiac monitoring for these children.
Area of Science:
- Pediatric critical care medicine
- Cardiology
- Septic shock research
Background:
- Septic shock is a life-threatening condition in children.
- Long-term effects of pediatric septic shock on cardiac function are not fully understood.
- Inotropic and vasoconstrictive agents are commonly used in treating pediatric septic shock.
Purpose of the Study:
- To evaluate the long-term cardiac effects in children who survived septic shock.
- To assess cardiac function in pediatric septic shock survivors treated with specific medications for extended periods.
- To identify potential cardiac abnormalities in pediatric septic shock survivors.
Main Methods:
- Cohort study design.
- Involved 108 pediatric septic shock survivors and 52 healthy controls.
- Assessed cardiac function through history, physical exam, ECG (rest, exercise, 24-hour Holter), and ventricular function tests.
Main Results:
- Most survivors had normal cardiac function and no symptoms.
- 6% of survivors exhibited cardiac abnormalities.
- Abnormalities included premature ventricular contractions and decreased left/right ventricular function.
Conclusions:
- Pediatric septic shock survivors generally exhibit good cardiac recovery.
- A subset of survivors may develop long-term cardiac issues like arrhythmias and ventricular dysfunction.
- Long-term cardiac follow-up is recommended for pediatric septic shock survivors, especially considering aging effects.
Objective:
To evaluate the long-term effects of septic shock on cardiac function in children treated with inotropic and/or vasoconstrictive agents for 24 hours or longer.
Design:
Cohort study.
Setting:
Tertiary pediatric intensive care unit and outpatient follow-up clinic.
Participants:
One hundred eight of 144 eligible children who were admitted to our tertiary pediatric intensive care unit with septic shock from 1995 through 2005 and were alive in 2006 were invited to participate and visit our outpatient follow-up clinic. Fifty-two healthy controls were included.
Main Exposure:
Septic shock survival.
Outcome Measures:
History, physical examination, electrocardiogram during rest and exercise, 24-hour electrocardiography registration, and left and right ventricular function.
Results:
No children had abnormalities when histories were taken or during physical examination that were attributable to cardiac dysfunction. Six children (6%) had cardiac abnormalities: polymorphic premature ventricular contractions during exercise and 24-hour electrocardiography registration (2 patients), decreased left ventricular function (2 patients), decreased left ventricular function and polymorphic premature ventricular contractions (1 patient), and decreased right ventricular function (1 patient).
Conclusions:
In this small and diverse group of pediatric septic shock survivors, we found an excellent recovery of cardiac performance in most patients. In a limited number of patients, we found rhythm disturbances and decreased ventricular function. We believe that, against the background of aging, long-term cardiac follow-up of these patients is important.
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