title: Prevalence and outcome of diastolic dysfunction in children with fluid refractory septic shock--a prospective observational study.
abstract: OBJECTIVE
  Our primary objective was to determine the prevalence and outcome of diastolic dysfunction in children with fluid refractory septic shock. The secondary objective was to determine possible early predictors of diastolic dysfunction.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  PICU of a tertiary care teaching hospital.
  
  
  METHODS
  Consecutive children 17 years old or younger with fluid refractory septic shock and not on mechanical ventilation admitted to our ICU from June 2011 to August 2012 were included. Survivors were followed up till 1 year of discharge (July 2013).
  
  
  METHODS
  Children were subjected to 2D echocardiography and qualitative cardiac troponin-T test within the first 6 hours of admission.
  
  
  RESULTS
  A total of 56 children were included. Median age was 7 years (interquartile range, 1.5, 14) and majority (52%) were males. Most common underlying diagnoses were meningitis and pneumonia. The prevalence of diastolic dysfunction was 41.1% (95% CI, 27.8-54.4), and mortality rate was 43% in those with diastolic dysfunction. At 1-year follow-up, residual dysfunction was present in only one of 11 of the survivors (11%). On univariable analysis of possible early predictors of diastolic dysfunction, we observed that these children tended to have higher mean central venous pressure (13 vs 6; p < 0.0001) and greater positivity for cardiac troponin-T (70% vs 36%; p = 0.01) compared with others. Although factors such as duration of illness and diastolic blood pressure were also lower in children with diastolic dysfunction compared with others, the difference was not statistically significant. On multivariable analysis, only the variable central venous pressure remained significant (adjusted odds ratio, 1.6; 95% CI, 1.12-2.14; p = 0.008).
  
  
  CONCLUSIONS
  Diastolic dysfunction is common in children with fluid refractory septic shock, and immediate outcomes may be poorer in such patients. Increased central venous pressure after initial fluid resuscitation may be an early indicator of diastolic dysfunction and warrant urgent bedside echocardiography to guide further management.
authors.affiliation: 1Department of Pediatrics, PGIMER, Dr RML Hospital, New Delhi, India. 2Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India. 3Department of Pediatrics, BL Kapoor Memorial Hospital, New Delhi, India.
authors.forename: Jhuma
authors.initials: J
authors.lastname: Sankar
authors.forename: Rashmi Ranjan
authors.initials: RR
authors.lastname: Das
authors.forename: Aditi
authors.initials: A
authors.lastname: Jain
authors.forename: Shashikant
authors.initials: S
authors.lastname: Dewangan
authors.forename: Praveen
authors.initials: P
authors.lastname: Khilnani
authors.forename: Dinesh
authors.initials: D
authors.lastname: Yadav
authors.forename: Nandkishore
authors.initials: N
authors.lastname: Dubey
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D054144:Heart Failure, Diastolic / Q000453:epidemiology* / Q000401:mortality; D006439:Hemodynamics; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012772:Shock, Septic / Q000453:epidemiology* / Q000401:mortality; D062606:Tertiary Care Centers; D020107:Troponin T / Q000097:blood
chemical_list: D020107:Troponin T