Hostname: page-component-848d4c4894-sjtt6 Total loading time: 0 Render date: 2024-06-19T23:23:52.211Z Has data issue: false hasContentIssue false

Critical care for paediatric patients with heart failure*

Published online by Cambridge University Press:  17 September 2015

John M. Costello*
Affiliation:
Division 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 Division 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
Mjaye L. Mazwi
Affiliation:
Division 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 Division 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
Mary E. McBride
Affiliation:
Division 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 Division 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
Katherine E. Gambetta
Affiliation:
Division 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
Osama Eltayeb
Affiliation:
Division 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 Division of Cardiothoracic and Vascular Surgery, Department 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
Conrad L. Epting
Affiliation:
Division 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 Division 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
*
Correspondence to: J. M. Costello, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Chicago, IL, 60611-2992, United States of America. Tel: +(312) 227 1551; Fax: +(312) 227 9765; E-mail: jmcostello@luriechildrens.org

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.

Type
Original Articles
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Presented at Johns Hopkins All Children’s Heart Institute, International Pediatric Heart Failure Summit, Saint Petersburg, Florida, United States of America, 4–5 February, 2015.

References

1. Rossano, JW, Kim, JJ, Decker, JA, et al. Prevalence, morbidity, and mortality of heart failure-related hospitalizations in children in the United States: a population-based study. J Card Fail 2012; 18: 459470.Google Scholar
2. Andrews, RE, Fenton, MJ, Ridout, DA, Burch, M. New-onset heart failure due to heart muscle disease in childhood: a prospective study in the United Kingdom and Ireland. Circulation 2008; 117: 7984.Google Scholar
3. McMurray, JJ, Adamopoulos, S, Anker, SD, et al. Esc guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33: 17871847.Google Scholar
4. Patterson, SW, Starling, EH. On the mechanical factors which determine the output of the ventricles. Journal Physiol 1914; 48: 357379.Google Scholar
5. McBride, ME, Costello, JM, Epting, CL. Heart failure: etiology, pathophysiology, and diagnosis, Chapter 72. In Nichols DG, Shaffner H (eds). Rogers Pediatric Intensive Care 5th edn. 2015, Wolters Kluwer, Philadelphia, PA, USA.Google Scholar
6. Macicek, SM, Macias, CG, Jefferies, JL, Kim, JJ, Price, JF. Acute heart failure syndromes in the pediatric emergency department. Pediatrics 2009; 124: e898e904.Google Scholar
7. Ramby, AL, Nguyen, N, Costello, JM. Cardiogenic shock masquerading as septic shock. Pediatr Emerg Med 2014; 15: 140148.Google Scholar
8. Fisher, JD, Nelson, DG, Beyersdorf, H, Satkowiak, LJ. Clinical spectrum of shock in the pediatric emergency department. Pediatr Emerg Care 2010; 26: 622625.Google Scholar
9. Teele, SA, Allan, CK, Laussen, PC, Newburger, JW, Gauvreau, K, Thiagarajan, RR. Management and outcomes in pediatric patients presenting with acute fulminant myocarditis. J Pediatr 2011; 158: 638.e1643.e1.Google Scholar
10. Berger, S, Dubin, AM. Arrhythmogenic forms of heart failure in children. Heart Fail Clin 2010; 6: 471481; viii.Google Scholar
11. Conway, J, Costello, JM, Gorenfolo, M, Hoffman, TM, Rossano, JW. Acute heart failure. In: Kirk R, Dipchand AI, Rosenthal DN (eds). ISHLT Guidelines for the Management of Pediatric Heart Failure. UAB Printing, Birmingham, AL, 2014: 201229.Google Scholar
12. Domico, M, Checchia, PA. Biomonitors of cardiac injury and performance: B-type natriuretic peptide and troponin as monitors of hemodynamics and oxygen transport balance. Pediatr Crit Care Med 2011; 12: S33S42.Google Scholar
13. Gazit, AZ, Cooper, DS. Emerging technologies. Pediatr Crit Care Med 2011; 12: S55S61.Google Scholar
14. Allen, M. Lactate and acid base as a hemodynamic monitor and markers of cellular perfusion. Pediatr Crit Care Med 2011; 12: S43S49.Google Scholar
15. Ghanayem, NS, Wernovsky, G, Hoffman, GM. Near-infrared spectroscopy as a hemodynamic monitor in critical illness. Pediatr Crit Care Med 2011; 12: S27S32.Google Scholar
16. Perkin, RM, Anas, N. Pulmonary artery catheters. Pediatr Crit Care Med 2011; 12: S12S20.Google Scholar
17. Sivarajan, VB, Bohn, D. Monitoring of standard hemodynamic parameters: heart rate, systemic blood pressure, atrial pressure, pulse oximetry, and end-tidal CO2. Pediatr Crit Care Med 2011; 12: S2S11.Google Scholar
18. Bronicki, RA. Venous oximetry and the assessment of oxygen transport balance. Pediatr Crit Care Med 2011; 12: S21S26.Google Scholar
19. Tibby, SM, Murdoch, IA. Monitoring cardiac function in intensive care. Arch Dis Child 2003; 88: 4652.Google Scholar
20. Gnaegi, A, Feihl, F, Perret, C. Intensive care physicians’ insufficient knowledge of right-heart catheterization at the bedside: time to act? Crit Care Med 1997; 25: 213220.Google Scholar
21. Goldstein, B, McNames, J, McDonald, BA, et al. Physiologic data acquisition system and database for the study of disease dynamics in the intensive care unit. Crit Care Med 2003; 31: 433441.Google Scholar
22. Murdoch, TB, Detsky, AS. The inevitable application of big data to health care. JAMA 2013; 309: 13511352.Google Scholar
23. Vender, RL, Betancourt, MF, Lehman, EB, Harrell, C, Galvan, D, Frankenfield, DC. Prediction equation to estimate dead space to tidal volume fraction correlates with mortality in critically ill patients. J Crit Care 2014; 29: e311e313.Google Scholar
24. Cannon, CM, Braxton, CC, Kling-Smith, M, Mahnken, JD, Carlton, E, Moncure, M. Utility of the shock index in predicting mortality in traumatically injured patients. J Trauma 2009; 67: 14261430.Google Scholar
25. Winchell, RJ, Hoyt, DB. Analysis of heart-rate variability: a noninvasive predictor of death and poor outcome in patients with severe head injury. J Trauma 1997; 43: 927933.Google Scholar
26. Herasevich, V, Pickering, BW, Dong, Y, Peters, SG, Gajic, O. Informatics infrastructure for syndrome surveillance, decision support, reporting, and modeling of critical illness. Mayo Clin Proc 2010; 85: 247254.Google Scholar
27. Norton, JM. Toward consistent definitions for preload and afterload. Adv Physiol Educ 2001; 25: 5361.Google Scholar
28. O'Connor, CM, Starling, RC, Hernandez, AF, et al. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med 2011; 365: 3243.Google Scholar
29. Mahle, WT, Cuadrado, AR, Kirshborn, PM, Kanter, KR, Simsic, JM. Nesiritide in infants and children with congestive heart failure. Pediatr Crit Care Med 2005; 6: 543546.Google Scholar
30. Jefferies, JL, Price, JF, Denfield, SW, et al. Safety and efficacy of nesiritide in pediatric heart failure. J Card Fail 2007; 13: 541548.Google Scholar
31. Gazit, AZ, Canter, CE. Impact of pulmonary vascular resistances in heart transplantation for congenital heart disease. Curr Cardiol Rev 2011; 7: 5966.Google Scholar
32. Caspi, J, Coles, JG, Benson, LN, et al. Age-related response to epinephrine-induced myocardial stress. A functional and ultrastructural study. Circulation 1991; 84: III394III399.Google Scholar
33. Caspi, J, Coles, JG, Benson, LN, et al. Effects of high plasma epinephrine and ca2+ concentrations on neonatal myocardial function after ischemia. J Thorac Cardiovasc Surg 1993; 105: 5967.Google Scholar
34. Abraham, WT, Adams, KF, Fonarow, GC, et al. In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the acute decompensated heart failure national registry (ADHERE). J Am Coll Cardiol 2005; 46: 5764.Google Scholar
35. Cuffe, MS, Califf, RM, Adams, KF Jr, et al. Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA 2002; 287: 15411547.Google Scholar
36. Pflugfelder, PW, O'Neill, BJ, Ogilvie, RI, et al. A canadian multicentre study of a 48 h infusion of milrinone in patients with severe heart failure. Can J Cardiol 1991; 7: 510.Google Scholar
37. Smith, AH, Owen, J, Borgman, KY, Fish, FA, Kannankeril, PJ. Relation of milrinone after surgery for congenital heart disease to significant postoperative tachyarrhythmias. Am J Cardiol 2011; 108: 16201624.Google Scholar
38. Chang, AC, Atz, AM, Wernovsky, G, Burke, RP, Wessel, DL. Milrinone: systemic and pulmonary hemodynamic effects in neonates after cardiac surgery. Crit Care Med 1995; 23: 19071914.Google Scholar
39. Hoffman, TM, Wernovsky, G, Atz, AM, et al. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation 2003; 107: 9961002.Google Scholar
40. Mebazaa, A, Nieminen, MS, Packer, M, et al. Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE randomized trial. JAMA 2007; 297: 18831891.Google Scholar
41. Packer, M, Colucci, W, Fisher, L, et al. Effect of levosimendan on the short-term clinical course of patients with acutely decompensated heart failure. JACC Heart Fail 2013; 1: 103111.Google Scholar
42. Ebade, AA, Khalil, MA, Mohamed, AK. Levosimendan is superior to dobutamine as an inodilator in the treatment of pulmonary hypertension for children undergoing cardiac surgery. J Anesth 2013; 27: 334339.Google Scholar
43. Pellicer, A, Riera, J, Lopez-Ortego, P, et al. Phase 1 study of two inodilators in neonates undergoing cardiovascular surgery. Pediatr Res 2013; 73: 95103.Google Scholar
44. Momeni, M, Rubay, J, Matta, A, et al. Levosimendan in congenital cardiac surgery: a randomized, double-blind clinical trial. J Cardiothorac Vasc Anesth 2011; 25: 419424.CrossRefGoogle ScholarPubMed
45. Bronicki, RA. Cardiopulmonary interaction. Pediatr Crit Care Med 2009; 10: 313322.Google Scholar
46. Gray, A, Goodacre, S, Newby, DE, Masson, M, Sampson, F, Nicholl, J. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 2008; 359: 142151.Google Scholar
47. Law, YM, Sharma, S, Feingold, B, Fuller, B, Devine, WA, Webber, SA. Clinically significant thrombosis in pediatric heart transplant recipients during their waiting period. Pediatr Cardiol 2013; 34: 334340.Google Scholar
48. Rajagopal, SK, Almond, CS, Laussen, PC, Rycus, PT, Wypij, D, Thiagarajan, RR. Extracorporeal membrane oxygenation for the support of infants, children, and young adults with acute myocarditis: a review of the Extracorporeal Life Support Organization registry. Crit Care Med 2010; 38: 382387.Google Scholar
49. Kane, DA, Thiagarajan, RR, Wypij, D, et al. Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease. Circulation 2010; 122: S241S248.Google Scholar
50. Thiagarajan, RR, Laussen, PC, Rycus, PT, Bartlett, RH, Bratton, SL. Extracorporeal membrane oxygenation to aid cardiopulmonary resuscitation in infants and children. Circulation 2007; 116: 16931700.Google Scholar
51. Almond, CS, Morales, DL, Blackstone, EH, et al. Berlin Heart EXCOR pediatric ventricular assist device for bridge to heart transplantation in US children. Circulation 2013; 127: 17021711.Google Scholar