title: Critical care for paediatric patients with heart failure.
abstract: This review offers a critical-care perspective on the pathophysiology, monitoring, and management of acute heart failure syndromes in children. An in-depth understanding of the cardiovascular physiological disturbances in this population of patients is essential to correctly interpret clinical signs, symptoms and monitoring data, and to implement appropriate therapies. In this regard, the myocardial force-velocity relationship, the Frank-Starling mechanism, and pressure-volume loops are discussed. A variety of monitoring modalities are used to provide insight into the haemodynamic state, clinical trajectory, and response to treatment. Critical-care treatment of acute heart failure is based on the fundamental principles of optimising the delivery of oxygen and minimising metabolic demands. The former may be achieved by optimising systemic arterial oxygen content and the variables that determine cardiac output: heart rate and rhythm, preload, afterload, and contractility. Metabolic demands may be decreased by a number of ways including positive pressure ventilation, temperature control, and sedation. Mechanical circulatory support should be considered for refractory cases. In the near future, monitoring modalities may be improved by the capture and analysis of complex clinical data such as pressure waveforms and heart rate variability. Using predictive modelling and streaming analytics, these data may then be used to develop automated, real-time clinical decision support tools. Given the barriers to conducting multi-centre trials in this population of patients, the thoughtful analysis of data from multi-centre clinical registries and administrative databases will also likely have an impact on clinical practice.
authors.affiliation: 1Division of CardiologyDepartment of Pediatrics and Surgery,Ann & Robert H. Lurie Children's Hospital of Chicago,Northwestern University Feinberg School of Medicine,Chicago,Illinois,United States of America.
authors.forename: John M
authors.initials: JM
authors.lastname: Costello
authors.affiliation: 1Division of CardiologyDepartment of Pediatrics and Surgery,Ann & Robert H. Lurie Children's Hospital of Chicago,Northwestern University Feinberg School of Medicine,Chicago,Illinois,United States of America.
authors.forename: Mjaye L
authors.initials: ML
authors.lastname: Mazwi
authors.affiliation: 1Division of CardiologyDepartment of Pediatrics and Surgery,Ann & Robert H. Lurie Children's Hospital of Chicago,Northwestern University Feinberg School of Medicine,Chicago,Illinois,United States of America.
authors.forename: Mary E
authors.initials: ME
authors.lastname: McBride
authors.affiliation: 1Division of CardiologyDepartment of Pediatrics and Surgery,Ann & Robert H. Lurie Children's Hospital of Chicago,Northwestern University Feinberg School of Medicine,Chicago,Illinois,United States of America.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Gambetta
authors.affiliation: 2Division of Critical Care MedicineDepartment of Pediatrics and Surgery,Ann & Robert H. Lurie Children's Hospital of Chicago,Northwestern University Feinberg School of Medicine,Chicago,Illinois,United States of America.
authors.forename: Osama
authors.initials: O
authors.lastname: Eltayeb
authors.affiliation: 1Division of CardiologyDepartment of Pediatrics and Surgery,Ann & Robert H. Lurie Children's Hospital of Chicago,Northwestern University Feinberg School of Medicine,Chicago,Illinois,United States of America.
authors.forename: Conrad L
authors.initials: CL
authors.lastname: Epting
mesh_terms: D000208:Acute Disease; D001794:Blood Pressure; D002302:Cardiac Output; D003422:Critical Care / Q000379:methods*; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D010372:Pediatrics; D011175:Positive-Pressure Respiration / Q000379:methods*
keywords: Heart failure; cardiogenic; critical care; paediatric; shock