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Elevated central venous pressure is associated with increased mortality in pediatric septic shock patients
Seung Jun Choi1, Eun-Ju Ha1, Won Kyoung Jhang1
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, Republic of Korea.
Insights
Central venous pressure (CVP) is linked to worse outcomes in pediatric septic shock. Higher CVP levels (>12 mmHg) independently predict mortality in children, highlighting its importance in pediatric intensive care.
Area of Science:
- Pediatric Critical Care Medicine
- Hemodynamics
- Septic Shock Pathophysiology
Background:
- Central venous pressure (CVP) impacts capillary blood flow and is associated with poor outcomes in adult septic shock.
- The relationship between CVP and outcomes in pediatric septic shock remains unclear.
Purpose of the Study:
- To investigate the association between central venous pressure (CVP) and mortality in pediatric septic shock patients.
- To determine if elevated CVP is an independent risk factor for mortality in this population.
Main Methods:
- Retrospective analysis of pediatric intensive care unit (PICU) patients with septic shock.
- Comparison of CVP levels at various time points between survivors and nonsurvivors.
- Multivariate analysis to identify independent risk factors for mortality.
Main Results:
- Nonsurvivors had significantly higher initial serum lactic acid, PRISM III scores, VIS, and 6-h CVP compared to survivors.
- A CVP greater than 12 mmHg was associated with significantly higher mortality rates (50.0%).
- Elevated CVP (>12 mmHg), high serum lactic acid, and mechanical ventilation were independent predictors of mortality.
Conclusions:
- Elevated central venous pressure is an independent risk factor for mortality in pediatric septic shock.
- Monitoring and managing CVP may be crucial for improving outcomes in pediatric septic shock.
Background:
Central venous pressure (CVP) is an important factor affecting capillary blood flow, and it is associated with poor outcomes in adult septic shock patients. However, whether a similar association exists in pediatric patients remains unclear.
Methods:
We retrospectively analyzed data from patients admitted to our pediatric intensive care unit (PICU) between February 2009 and July 2015. Patients were divided into two groups-survivors and nonsurvivors-according to 28-day mortality. The associations between (a) mortality and CVP at 6, 24, 48, and 72 h after initiating treatment for established septic shock was analyzed and (b) initial serum lactic acid levels and 6-h CVP.
Results:
Two hundred twenty-six patients were included in this study, and the mortality rate was 29.6% (67 deaths, nonsurvivor group). Initial serum lactic acid levels, Pediatric Risk of Mortality (PRISM) III score, and Vasoactive-Inotropic Score (VIS) within 24 h after PICU admission were significantly higher in the nonsurvivors than in survivors (1.3 [0.9, 2.4] vs. 3.9 [1.6, 8.0] mmol/l, 11.0 [7.0, 15.0] vs. 17.0 [10.0, 21.5], 12.0 [7.0, 25.0] vs. 22.5 [8.0, 55.0], respectively with p-values < 0.001, < 0.001, and 0.009, respectively). In addition, compared to survivors, a greater percentage of nonsurvivors required mechanical ventilation (92.5% vs. 51.6%, p < 0.001) and showed a greater extent of fluid overload at 48 h after admission (3.9% vs. 1.9%, p = 0.006), along with higher 6-h CVP (10.0 [7.0, 16.0] vs. 8.0 [5.0, 11.0] mmHg, p < 0.001). Patient survival according to levels of CVP (CVP < 8 mmHg, CVP 8-12 mmHg, or CVP > 12 mmHg) showed that the CVP > 12-mmHg group had significantly greater mortality rates (50.0%, p = 0.002) than the other groups (21.3% and 27.5%). Furthermore, multivariate analysis identified significant associations of CVP > 12 mmHg, serum lactic acid levels, and the need for mechanical ventilation with mortality (OR: 2.74, 1.30, and 12.51, respectively; 95% CI: 1.11-6.72, 1.12-1.50, and 4.12-37.96, respectively).
Conclusions:
Elevated CVP is an independent risk factor for mortality in pediatric septic shock patients.
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