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Aziz, Miriam Magdy
- Bedside Evaluation of Fluid Responsiveness in Shock State using Electrical Cardiometry
Authors
1 Pediatrics Department, Cairo University, Cairo, EG
Source
Indian Journal of Public Health Research & Development, Vol 10, No 12 (2019), Pagination: 1570-1576Abstract
Background: The initial hemodynamic management for pediatric shocked patients is giving aggressive fluid resuscitation, however fluid overload increases mortality and morbidity, so assessment and monitoring of fluid status have greatest benefit for critical patients to keep hemodynamic stability. Electrical cardiometry is an accurate, easy, and safe method for hemodynamic measurement, and can be used to monitor fluid responsiveness in critically ill patients.
Objectives: To examine stroke volume variation (SVV), evaluated through electrical cardiometry as a predictor of fluid responsiveness in management of shock.
Patients & Method: This was a cohort study done by observation of 60 shocked pediatric patients who received fluid therapy in the Intensive care units at Cairo University Pediatric Hospitals from July till December 2018.
Results: On comparing between patients who were volume non-responders versus volume responders, SVV was highly significant as it was higher in non-responders (P<0.000), also it was higher in patients who died than those who were discharged (p =0.002), it can be used as predictor of mortality with sensitivity of 80%, specificity of 75%, it also can be used as predictor of volume responsiveness with sensitivity of 85%, specificity of 92%.
Conclusion: Monitoring SVV, using electrical cadiometery could guide fluid therapy in critically ill pediatric cases, with beneficial impacts on morbidities and mortalities.
Keywords
Fluid Responsiveness-Shock-electrical Cardiometry-Stroke Volume Variation.
- Value of Cardiac Enzymes in Early Diagnosis of Cardiac Dysfunction in Pediatric Septic Shock
Authors
1 Lecturer of Pediatrics, Faculty of Medicine, Cairo University, EG
2 Professor of Pediatrics, Faculty of Medicine, Cairo University, EG
3 Professor of Chemical Pathology, Faculty of Medicine, Cairo University, EG
4 Msc Pediatrics, Cairo University, EG
Source
Indian Journal of Public Health Research & Development, Vol 10, No 11 (2019), Pagination: 3398-3403Abstract
Purpose: Sepsis induced myocardial dysfunction (SIMD) is a severe complication in pediatric septic shock. The purpose of this study was to study serum cardiac troponin I (cTnI) as a biomarker for early detection of myocardial cell injury in pediatric severe sepsis and septic shock and to investigate its association with ECHO findings and clinical outcomes in pediatric septic shock.
Methods: This study is a case control study that was carried out at Cairo University Children, s Hospital pediatric intensive care units (PICUs) from October 2016 to April 2017. Study included 80 patients whose ages ranged from 3 months to 12 years (40 normal controls coming to the outpatient clinics &40 cases in the PICUs who had clinical signs of severe sepsis and septic shock: 25 males and 15 females with a median age of 18 months). Bedside ECHO was done to the 40 included cases in the PICU to evaluate LV systolic function, LV diastolic function and RV function.
Results: Serum cTnI was elevated in 33 of the 40 included cases (82.5%) and none of the controls showed cTnI elevation (0%). Prevalence of LV systolic dysfunction was 77.5%, LV diastolic dysfunction was 52.5% and RV dysfunction was 52.5%. Serum cTnI was correlated with LV systolic function but not with LV diastolic function, RV function, PRISM score or mortality.
Conclusion: Elevated serum cTnI is highly prevalent in pediatric septic shock and is associated with decreased contractile function of the heart but not with clinical outcomes.