Early echocardiographic assessment in pediatric acute respiratory distress syndrome revealed pulmonary hypertension in 35% of patients and elevated EPASP in 41.7% of deceased patients (P=0.024).
Observational (n=40)
Early echocardiographic assessment demonstrates that right ventricular dysfunction and pulmonary hypertension are common in pediatric acute respiratory distress syndrome and correlate with higher mortality and need for advanced support.
Introduction Understanding the dynamics of the heart in Pediatric Acute Respiratory Syndrome (PARDS) will provide intensivists with a better understanding of management. This prompted us to conduct our study. Objective To study the RV dysfunction in PARDS. Patients and methods This is a prospective study carried out on 40 consecutive patients with PARDS. PARDS was defined according to the Pediatric Acute Lung Injury Consensus Conference Group definition (PALICC). Patients had echocardiography focusing on the right ventricle’s (RV) functions within 24 h. Results Pulmonary hypertension (PHT) was present in 35% of patients, elevated Estimated Pulmonary Artery Systolic Pressure (EPASP) in 30%, elevated Estimated Pulmonary Artery Mean Pressure (EPAMP) in 17.5% and right side dilatation in 30%. RV Fractional Area Change (FAC)% was reduced in 27.5% of patients. Tricuspid Annular Plane Systolic Excursion (TAPSE) was low in 42% of patients (statistically significant P < 0.001). The RV Index of Myocardial Performance (MPI) was prolonged in 60% of patients (statistically significant P < 0/001). The mean of Tricuspid (T) Tricuspid Tissue Doppler Velocity of the Early Wave/Tricuspid Tissue Doppler Velocity of the Acceleration Wave (E’/A’) ratio was lower than the normal referenced value (P < 0.001), EPASP was statistically significantly higher in deceased patients (41.7%, P = 0.024) in comparison to survivors. RV FAC% was lower in deceased patients, and it was statistically significantly lower than in discharged patients (P = 0.021). TAPSE was lower in deceased patients (P < 0.067). Tricuspid Velocity of the Systolic Excursion Wave (T S’) was lower in deceased patients (statistically significant P = 0.015). Patients requiring high-frequency oscillation ventilation (HFOV) had higher EPASP (66.7% P = 0.001), higher EPAMP (44.4% P = 0.001), and PHT (88.9% P < 0.001). Patients requiring inotropic support had more PHT (46.4% P = 0.03) and lower TAPSE (P < 0.019). Conclusion In conclusion, the study showed that early RV dysfunction and PHT are common in PARDS and statistically related to mortality.
El-Nawawy et al. (Tue,) conducted a observational in Pediatric Acute Respiratory Distress Syndrome (PARDS) (n=40). Echocardiography was evaluated on Right ventricular dysfunction and pulmonary hypertension. Early echocardiographic assessment in pediatric acute respiratory distress syndrome revealed pulmonary hypertension in 35% of patients and elevated EPASP in 41.7% of deceased patients (P=0.024).