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A Single-Center Descriptive Analysis of Interventions for Hypotension in Children: A Retrospective Cohort Study
Christopher S McLaughlin1, Vikas N O'Reilly-Shah2,3, L Daniela Smith1
1Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Insights
Pediatric intraoperative hypotension management varies by age, with lower blood pressure intervention thresholds in younger children. Albumin and phenylephrine were common treatments, highlighting the need for standardized pediatric care guidelines.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Hemodynamic Monitoring
Background:
- Pediatric intraoperative hemodynamic management lacks standardized goals due to age-related physiological variability.
- Inconsistent definitions of intraoperative hypotension contribute to practice variations in pediatric surgery.
Purpose of the Study:
- To identify age-specific blood pressure thresholds triggering clinical interventions during pediatric noncardiac surgery.
- To determine the most frequent interventions used for managing intraoperative hypotension in pediatric patients.
Main Methods:
- A retrospective observational study analyzed 37,958 pediatric anesthesia records (age <18 years) from 2015-2023.
- Patients were categorized into infants (0-12 months), preschool (1-6 years), children (7-12 years), and teenagers (13-17 years).
- Interventions included vasopressors (ephedrine, phenylephrine, epinephrine, norepinephrine, vasopressin) and 5% albumin; lowest mean arterial pressure associated with intervention was analyzed.
Main Results:
- Median arterial pressure associated with intervention decreased with age: 36 mmHg (infants), 44 mmHg (preschool), 51 mmHg (children), and 57 mmHg (teenagers).
- The most common interventions were 5% albumin and phenylephrine.
- Intervention rates were lower than those reported in adults.
Conclusions:
- Intraoperative hypotension management in pediatric patients shows lower intervention thresholds in younger age groups.
- Intravascular volume expansion (5% albumin) is frequently used for infants, while vasopressors are common in older children.
- Multicenter studies are needed to establish standardized pediatric intervention thresholds and evaluate their clinical impact.
Background:
Intraoperative hemodynamic management goals in pediatric patients vary significantly with age. Physiologic variability and the absence of a widely accepted definition of intraoperative hypotension contribute to inconsistent treatment thresholds and practice variation.
Aims:
The primary aim was to observe which blood pressure thresholds in various age groups led to clinical intervention in noncardiac surgery. The secondary aim was to determine the most commonly employed treatment interventions.
Methods:
A single-center, retrospective, observational cohort study analyzed anesthesia records for 37 958 pediatric patients aged < 18 years of age who underwent noncardiac surgery and general anesthesia at our institution from January 1, 2015, through December 31, 2023. Age groups included: infants (0-12 months), preschool (1-6 years), children (7-12 years), and teenagers (13-17 years). The primary outcome was the adjusted rate of intervention, defined as any bolus of ephedrine, phenylephrine, epinephrine, norepinephrine, vasopressin, or 5% albumin. An algorithmic approach was used to examine the time epoch both before (6 min) and after (3 min) any study-defined interventions to identify the lowest mean arterial pressure that was associated with an intervention.
Results:
Following exclusions, 37 958 anesthetic records were analyzed in this cohort. The median arterial pressure value and interquartile range associated with an intervention were: 36 mmHg [29, 43] in infants, 44 mmHg [38.5, 52] in preschool, 51 mmHg [44, 58] in children, and 57 mmHg [51, 63] in teenagers. The most common intervention was 5% albumin, followed by phenylephrine.
Conclusion:
Intervention rates in pediatric patients were lower than those reported in adults, with intervention thresholds decreasing with younger age. Use of intravascular volume expansion appears to be more commonly used to treat hypotension in infants compared to older children. These findings highlight the need for multicenter studies to establish standardized intervention thresholds and assess their impact on clinical outcomes.
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