Cardiovascular Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

Peta M.A. Alexander, Paul A. Checchia, Lindsay M. Ryerson, Desmond Bohn, Michelle Eckerle, Michael Gaies, Peter Laussen, Howard Jeffries, Ravi R. Thiagarajan, Lara Shekerdemian, Melania M. Bembea, Jerry J. Zimmerman, Niranjan Kissoon, Marie E Steiner

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Abstract

CONTEXT: Cardiovascular dysfunction is associated with poor outcomes in critically ill children. OBJECTIVE: We aim to derive an evidence-informed, consensus-based definition of cardiovascular dysfunction in critically ill children. DATA SOURCES: Electronic searches of PubMed and Embase were conducted from January 1992 to January 2020 using medical subject heading terms and text words to define concepts of cardiovascular dysfunction, pediatric critical illness, and outcomes of interest. STUDY SELECTION: Studies were included if they evaluated critically ill children with cardiovascular dysfunction and assessment and/or scoring tools to screen for cardiovascular dysfunction and assessed mortality, functional status, organ-specific, or other patient-centered outcomes. Studies of adults, premature infants (≤36 weeks gestational age), animals, reviews and/or commentaries, case series (sample size ≤10), and non-English-language studies were excluded. Studies of children with cyanotic congenital heart disease or cardiovascular dysfunction after cardiopulmonary bypass were excluded. DATA EXTRACTION: Data were abstracted from each eligible study into a standard data extraction form, along with risk-of-bias assessment by a task force member. RESULTS: Cardiovascular dysfunction was defined by 9 elements, including 4 which indicate severe cardiovascular dysfunction. Cardiopulmonary arrest (>5 minutes) or mechanical circulatory support independently define severe cardiovascular dysfunction, whereas tachycardia, hypotension, vasoactive-inotropic score, lactate, troponin I, central venous oxygen saturation, and echocardiographic estimation of left ventricular ejection fraction were included in any combination. There was expert agreement (>80%) on the definition. LIMITATIONS: All included studies were observational and many were retrospective. CONCLUSIONS: The Pediatric Organ Dysfunction Information Update Mandate panel propose this evidence-informed definition of cardiovascular dysfunction.

Original languageEnglish (US)
Pages (from-to)S39-S47
JournalPediatrics
Volume149
Issue numberSupplement_1
DOIs
StatePublished - Jan 1 2022

Bibliographical note

Funding Information:
FUNDING: Boston Children’s Hospital Division of Cardiac Intensive Care (Drs Alexander, Laussen, and Thiagarajan), Texas Children’s Hospital (Drs Checchia and Shekerdemian), University of Michigan Department of Pediatrics (Dr Gaies), British Columbia Children’s Hospital (Dr Kissoon), and Howard Jeffries, MD, contributed funds toward publication cost for this article. Funded by National Institutes of Health National Institute of Neurological Disorders and Stroke grant R01NS106292 (Dr Bembea). Funded by the National Institutes of Health (NIH).

Funding Information:
Boston Children's Hospital Division of Cardiac Intensive Care (Drs Alexander, Laussen, and Thiagarajan), Texas Children's Hospital (Drs Checchia and Shekerdemian), University of Michigan Department of Pediatrics (Dr Gaies), British Columbia Children's Hospital (Dr Kissoon), and Howard Jeffries, MD, contributed funds toward publication cost for this article. Funded by National Institutes of Health National Institute of Neurological Disorders and Stroke grant R01NS106292 (Dr Bembea). Funded by the National Institutes of Health (NIH).

Publisher Copyright:
Copyright © 2021 by the American Academy of Pediatrics

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