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Cardiovascular Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference.

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A new definition for cardiovascular dysfunction in critically ill children was developed. This evidence-informed consensus provides a framework for identifying severe cases and guiding treatment in pediatric critical care.

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Area of Science:

  • Pediatric Critical Care Medicine
  • Cardiovascular Physiology
  • Clinical Definitions

Background:

  • Cardiovascular dysfunction is a significant predictor of adverse outcomes in critically ill children.
  • A standardized definition is crucial for consistent diagnosis and management.

Purpose of the Study:

  • To establish an evidence-informed, consensus-based definition of cardiovascular dysfunction in critically ill children.
  • To identify key elements and criteria for defining severe cardiovascular dysfunction.

Main Methods:

  • Conducted comprehensive electronic literature searches of PubMed and Embase (1992-2020).
  • Included studies evaluating critically ill children with cardiovascular dysfunction and relevant assessment tools.
  • Excluded studies on adults, premature infants, animals, reviews, and specific pediatric populations.

Main Results:

  • Developed a definition comprising 9 elements, with 4 indicating severe cardiovascular dysfunction.
  • Severe dysfunction identified by cardiopulmonary arrest (>5 minutes) or mechanical circulatory support.
  • Other elements include tachycardia, hypotension, lactate, vasoactive-inotropic score, troponin I, and central venous oxygen saturation.

Conclusions:

  • Propose an evidence-informed definition for cardiovascular dysfunction in critically ill children.
  • This definition achieved expert agreement (>80%) and can aid in clinical practice and research.
  • The definition incorporates multiple physiological and therapeutic parameters for comprehensive assessment.