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Published on: May 21, 2019
Prognostic value of baseline carotid blood flow in critically ill children with septic shock
Fatma Mamdouh1,2, Hafez Bazaraa1,2, Ahmed Baz3
1Department of Critical Care, Specialized Children Hospital, Cairo University, Cairo, Egypt.
Insights
Carotid blood flow (CBF) measured by ultrasound may help predict mortality in pediatric septic shock. Survivors showed higher CBF than non-survivors, though type of shock was the strongest predictor in multivariate analysis.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular physiology
- Diagnostic imaging
Background:
- Hemodynamic monitoring in ICUs is shifting towards less invasive techniques.
- Carotid blood flow (CBF) has been proposed as a non-invasive indicator for cardiac output (CO).
- Septic shock in children presents significant mortality risks, necessitating accurate prognostic tools.
Purpose of the Study:
- To evaluate the predictive value of carotid artery ultrasound for mortality in pediatric patients with septic shock.
- To assess the correlation between CBF and patient outcomes, including survival and ICU length of stay.
Main Methods:
- A cohort of 40 children diagnosed with septic shock was studied.
- Hemodynamic parameters were assessed using electrical cardiometry and transthoracic 2-D echocardiography.
- Carotid blood flow (CBF) was measured using GE Vivid S5 ultrasound and dedicated software.
Main Results:
- Of the 40 patients, 14 (35%) died during the study period.
- Survivors exhibited significantly higher CBF compared to non-survivors (p=0.033).
- Multivariate analysis indicated that the type of shock, not CBF, was the significant predictor of mortality.
Conclusions:
- Carotid blood flow assessment shows potential as a prognostic marker in pediatric septic shock.
- While CBF was higher in survivors, its independent predictive power for mortality requires further investigation.
- Type of shock remains a critical factor in predicting mortality in this population.
Background And Aim:
Hemodynamic monitoring and cardiac output (CO) assessment in the ICU have been trending toward less invasive methods. Carotid blood flow (CBF) was suggested as a candidate for CO assessment. The present study aimed to test the value of carotid artery ultrasound analysis in prediction of mortality in pediatric patients with septic shock.
Methodology/Principal Finding:
Forty children with septic shock were included in the study. Upon admission, patients were subjected to careful history taking and thorough clinical examination. The consciousness level was assessed by the Glasgow Coma Scale (GCS). Laboratory assessment included complete blood count, C-reactive protein, arterial blood gases, serum electrolytes, and liver and kidney function tests. Electrical cardiometry was used to evaluate hemodynamic parameters. Patients were also subjected to transthoracic 2-D echocardiography. CBF was evaluated using GE Vivid S5 ultrasound device through dedicated software. At the end of study, 14 patients (35.0%) died. It was found that survivors had significantly higher CBF when compared non-survivors [median (IQR): 166.0 (150.0-187.3) versus 141.0 (112.8-174.3), p = 0.033]. In addition, it was noted that survivors had longer ICU stay when compared with non-survivors [16.5 (9.8-31.5) versus 6.5 (3.0-19.5) days, p = 0.005]. ROC curve analysis showed that CBF could significantly distinguish survivors from non-survivors [AUC (95% CI): 0.3 (0.11-0.48), p = 0.035] (Fig 2). Univariate logistic regression analysis identified type of shock [OR (95% CI): 28.1 (4.9-162.4), p<0.001], CI [OR (95% CI): 0.6 (0.43-0.84), p = 0.003] and CBF [OR (95% CI): 0.98 (0.96-0.99), p = 0.031]. However, in multivariate analysis, only type of shock significantly predicted mortality.
Conclusions:
CBF assessment may be a useful prognostic marker in children with septic shock.
