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

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.