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Updated: Apr 23, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Prevalence and outcome of diastolic dysfunction in children with fluid refractory septic shock--a prospective
Jhuma Sankar1, Rashmi Ranjan Das, Aditi Jain
11Department of Pediatrics, PGIMER, Dr RML Hospital, New Delhi, India. 2Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India. 3Department of Pediatrics, BL Kapoor Memorial Hospital, New Delhi, India.
Insights
Diastolic dysfunction is prevalent in pediatric septic shock, increasing mortality. Elevated central venous pressure may predict this condition, necessitating early echocardiography for better management.
Area of Science:
- Pediatric critical care medicine
- Cardiology
- Septic shock management
Background:
- Fluid-refractory septic shock in children is a critical condition with significant morbidity.
- Diastolic dysfunction can impair cardiac function but is understudied in pediatric septic shock.
Purpose of the Study:
- To determine the prevalence and outcomes of diastolic dysfunction in children with fluid-refractory septic shock.
- To identify early predictors of diastolic dysfunction in this patient population.
Main Methods:
- Prospective observational study in a pediatric intensive care unit.
- Included children aged 17 years or younger with fluid-refractory septic shock.
- Utilized 2D echocardiography and cardiac troponin-T testing within 6 hours of admission.
Main Results:
- Diastolic dysfunction was present in 41.1% of children, associated with a 43% mortality rate.
- Higher central venous pressure (CVP) and positive cardiac troponin-T were associated with diastolic dysfunction.
- Multivariable analysis identified elevated CVP as a significant predictor (aOR, 1.6).
Conclusions:
- Diastolic dysfunction is common and linked to poorer outcomes in pediatric septic shock.
- Increased central venous pressure post-resuscitation may indicate diastolic dysfunction.
- Early echocardiography is recommended for guiding management in these high-risk children.
Objectives:
Our primary objective was to determine the prevalence and outcome of diastolic dysfunction in children with fluid refractory septic shock. The secondary objective was to determine possible early predictors of diastolic dysfunction.
Design:
Prospective observational study.
Setting:
PICU of a tertiary care teaching hospital.
Patients:
Consecutive children 17 years old or younger with fluid refractory septic shock and not on mechanical ventilation admitted to our ICU from June 2011 to August 2012 were included. Survivors were followed up till 1 year of discharge (July 2013).
Interventions:
Children were subjected to 2D echocardiography and qualitative cardiac troponin-T test within the first 6 hours of admission.
Measurements And Main Results:
A total of 56 children were included. Median age was 7 years (interquartile range, 1.5, 14) and majority (52%) were males. Most common underlying diagnoses were meningitis and pneumonia. The prevalence of diastolic dysfunction was 41.1% (95% CI, 27.8-54.4), and mortality rate was 43% in those with diastolic dysfunction. At 1-year follow-up, residual dysfunction was present in only one of 11 of the survivors (11%). On univariable analysis of possible early predictors of diastolic dysfunction, we observed that these children tended to have higher mean central venous pressure (13 vs 6; p < 0.0001) and greater positivity for cardiac troponin-T (70% vs 36%; p = 0.01) compared with others. Although factors such as duration of illness and diastolic blood pressure were also lower in children with diastolic dysfunction compared with others, the difference was not statistically significant. On multivariable analysis, only the variable central venous pressure remained significant (adjusted odds ratio, 1.6; 95% CI, 1.12-2.14; p = 0.008).
Conclusions:
Diastolic dysfunction is common in children with fluid refractory septic shock, and immediate outcomes may be poorer in such patients. Increased central venous pressure after initial fluid resuscitation may be an early indicator of diastolic dysfunction and warrant urgent bedside echocardiography to guide further management.
