BACKGROUND AND AIM Hemodynamic monitoring and cardiac output (CO) assessment in the ICU have been trending toward less invasive methods. Carotid blood flow (CBF) was suggested as a candidate for CO assessment. The present study aimed to test the value of carotid artery ultrasound analysis in prediction of mortality in pediatric patients with septic shock. METHODOLOGY/PRINCIPAL FINDING Forty children with septic shock were included in the study. Upon admission, patients were subjected to careful history taking and thorough clinical examination. The consciousness level was assessed by the Glasgow Coma Scale (GCS). Laboratory assessment included complete blood count, C-reactive protein, arterial blood gases, serum electrolytes, and liver and kidney function tests. Electrical cardiometry was used to evaluate hemodynamic parameters. Patients were also subjected to transthoracic 2-D echocardiography. CBF was evaluated using GE Vivid S5 ultrasound device through dedicated software. At the end of study, 14 patients (35.0%) died. It was found that survivors had significantly higher CBF when compared non-survivors [median (IQR): 166.0 (150.0-187.3) versus 141.0 (112.8-174.3), p = 0.033]. In addition, it was noted that survivors had longer ICU stay when compared with non-survivors [16.5 (9.8-31.5) versus 6.5 (3.0-19.5) days, p = 0.005]. ROC curve analysis showed that CBF could significantly distinguish survivors from non-survivors [AUC (95% CI): 0.3 (0.11-0.48), p = 0.035] (Fig 2). Univariate logistic regression analysis identified type of shock [OR (95% CI): 28.1 (4.9-162.4), p<0.001], CI [OR (95% CI): 0.6 (0.43-0.84), p = 0.003] and CBF [OR (95% CI): 0.98 (0.96-0.99), p = 0.031]. However, in multivariate analysis, only type of shock significantly predicted mortality. CONCLUSIONS CBF assessment may be a useful prognostic marker in children with septic shock.

中文翻译：

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脓毒症休克危重儿童基线颈动脉血流的预后价值。


背景和目的 ICU 中的血流动力学监测和心输出量 (CO) 评估已趋向于采用侵入性较小的方法。建议将颈动脉血流 (CBF) 作为 CO 评估的候选指标。本研究旨在测试颈动脉超声分析在预测感染性休克儿科患者死亡率中的价值。方法/主要发现 该研究纳入了 40 名感染性休克儿童。入院后，患者接受了仔细的病史采集和彻底的临床检查。意识水平通过格拉斯哥昏迷量表（GCS）进行评估。实验室评估包括全血细胞计数、C反应蛋白、动脉血气、血清电解质以及肝肾功能测试。心电图用于评估血流动力学参数。患者还接受了经胸二维超声心动图检查。 CBF 使用 GE Vivid S5 超声设备通过专用软件进行评估。研究结束时，14 名患者（35.0%）死亡。结果发现，与非幸存者相比，幸存者的 CBF 显着更高[中位数 (IQR)：166.0 (150.0-187.3) 与 141.0 (112.8-174.3)，p = 0.033]。此外，值得注意的是，与非幸存者相比，幸存者在 ICU 停留的时间更长[16.5 (9.8-31.5) 天 vs 6.5 (3.0-19.5) 天，p = 0.005]。 ROC曲线分析显示，CBF可以显着区分幸存者和非幸存者[AUC（95% CI）：0.3（0.11-0.48），p = 0.035]（图2）。单变量逻辑回归分析确定休克类型 [OR (95% CI): 28.1 (4.9-162.4), p<0.001], CI [OR (95% CI): 0.6 (0.43-0.84), p = 0.003]和 CBF [OR (95% CI)：0.98 (0.96-0.99)，p = 0.031]。然而，在多变量分析中，只有休克类型可以显着预测死亡率。 结论 CBF 评估可能是感染性休克儿童的一个有用的预后指标。