Hemodynamic Response to Fluid Boluses for Hypotension in Children in a Cardiac ICU. Issue 1 (January 2021)

• Record Type: Journal Article
• Authors: Gelbart, Ben; Harrois, Anatole; Gardiner, Lauren; Mcgregor, Cherie; Bitker, Laurent; Van Zanten, Eva; Beel, Emma; Bellomo, Rinaldo; Duke, Trevor; Butt, Warwick
• Is Part Of: Pediatric critical care medicine. Volume 22:Issue 1(2021)
• Publication Date: 2021-01
• Subjects: albumins -- blood pressure -- hemodynamics -- child -- fluid therapy -- thoracic surgery; Pediatric intensive care -- Periodicals; Pediatric emergencies -- Periodicals; 618.05
• DOI: 10.1097/PCC.0000000000002607
• Languages: English
• ISSNs: 1529-7535

Abstract

Abstract : Objectives: To describe the hemodynamic response to fluid boluses for hypotension in children in a cardiac ICU. Design: A prospective, observational study. Setting: Single-centered cardiac ICU. Patients: Children in a cardiac ICU with hypotension. Interventions: Clinician prescribed fluid bolus. Measurements and Main Results: Sixty-four fluid boluses were administered to 52 children. Fluid composition was 4% albumin in 36/64 (56%), 0.9% saline in 18/64 (28%), and cardiopulmonary bypass pump blood in 10/64 (16%). The median volume and duration were 5.0 mL/kg (interquartile range, 4.8–5.4) and 8 minutes (interquartile range, 4–19), respectively. Hypovolemia/low filling pressures was the most common additional indication (25/102 [25%]). Mean arterial pressure response, defined as a 10% increase from baseline, occurred in 42/64 (66%) of all fluid boluses at a median time of 6 minutes (interquartile range, 4–11). Mean arterial pressure responders had a median peak increase in the mean arterial pressure of 15 mm Hg (43 mm Hg [interquartile range, 29–50 mm Hg] to 58 mm Hg [interquartile range, 49–65 mm Hg]) at 17 minutes (interquartile range, 14–24 min) compared with 4 mm Hg (48 mm Hg [interquartile range, 40–51 mm Hg] to 52 mm Hg [interquartile range, 45–56 mm Hg]) at 10 minutes (interquartile range, 3–18 min) in nonresponders. Dissipation of mean arterial pressure response, when defined as a subsequent decrement in mean arterial pressure below 10%, 5%, and 2% increases from baseline, occurred in 28/42 (67%), 18/42 (43%), and 13/42 (31%) of mean arterial pressure responders, respectively. Cardiopulmonary bypass pump blood was strongly associated with peak change in mean arterial pressure from baseline (coefficient 11.0 [95% CI, 4.3–17.7]; p = 0.02). Fifty out of 64 (78%) were receiving a vasoactive agent. However, change in vasoactive inotrope score was not associated with change in mean arterial pressure (coefficient 2.3 [95% CI, –2.5 to –7.2]; p = 0.35). Timing from admission, nor fluid bolus duration, influenced mean arterial pressure response. Conclusions: In children with hypotension in a cardiac ICU, the median dose and duration of fluid boluses were 5 mL/kg and 8 minutes. Peak response occurred shortly following administration and commonly returned to baseline. Abstract : Supplemental Digital Content is available in the text.