Non-Invasive Bed-Side Assessment of Pulmonary Vascular Resistance in Critically Ill Pediatric Patients with Acute Respiratory Distress Syndrome
Journal Title: Journal Of Pediatric Critical Care - Year 2015, Vol 2, Issue 3
Abstract
Aim: To evaluate the degree of pulmonary hypertension as well as alterations in the pulmonary vascular resistance in critically ill children with acute respiratory distress syndrome (ARDS) using bed-side echocardiography. Methods: The study included 20 consecutive critically ill mechanically ventilated ARDS pediatric patients selected from the PICU of Ain Shams University Hospital. Patients with underlying heart disease or chronic pulmonary disease were excluded. Doppler echocardiography was done to assess the pulmonary artery pressure. Pulmonary vascular resistance was calculated using the equation (PVR= TRV/TVI (RVOT) x10 + 0.16) with a cut off value of 0.175 to determine PVR > 2 wood unit. Age and sex matched children were assessed by echocardiography as a control group. Results: Ninety percent of patients had elevated RVSP and PVR when compared to normal standard values. The median and IQR of RVSP were higher among patients 44.5 (36.3-48.5mmHg) when compared to controls 25 (23.5-26 mmHg) (p<0.001) as well as the median and IQR of the PVR 2.6(2.1-3.4) when compared to controls 1.5(1.1- 1.6) (p<0.001).There was a significant negative correlation between hypoxemic index (PaO2 /FiO2) and TRV (r = - 0.474, P =0.035) and a significant positive correlation between FiO2 and TRV(r =0.469, P =0.037), FiO2 and Pulmonary artery end-diastolic pressure (PAEDP) (r =0.529, P = 0.017) and between Peak inspiratory pressure (PIP) and PVR (r =0.513, P = 0.021). Conclusion: Hypoxemia resulted from ARDS can adversely affect the pulmonary vascular bed. Management of pulmonary vascular dysfunction could represent a future therapeutic target for patients with ARDS.
Authors and Affiliations
Hanan Mohamed Ibrahim, Nevin Mamdouh Habeeb, Marwa Moustapha Al-Fahham, Ahmed Gamal Youssif
Keywords
Related Articles
- EP ID EP337114
- DOI 10.21304/2015.0203.00081
- Views 75
- Downloads 0
India in Forefront of Pediatric Critical Care Research
.
Clinical Profile Of Patients With Super Refractory Status Epilepticus In Pediatric Intensive Care Unit
.
Acute Flaccid Paralysis In Young Children: “Watch their back”
Background : Congenital dermal sinus is a developmental malformation which may be associated with sinus tract between the skin and the deeper tissues even spinal cord. Hence, can have complicated presentations like gait...
Health related quality of life in survivors of acute respiratory illness who required invasive respiratory support in a tertiary Pediatric ICU - A Prospective observational study
To assess long term health related quality of life in all PICU survivors with acute respiratory illness requiring invasive respiratory support, three to eight years after discharge
Sepsis Definitions - Changing Perspectives
The evolving changes in the “defi nition” of sepsis refl ect both a new emphasis on precision, needed for research, and an ever-expanding knowledge of its pathophysiology. Even with the recent revision of sepsis defi nit...