.: ORİJİNAL ARAŞTIRMA
Retrospective Evaluation of the Cases Presenting to the Pediatric Intensive Care Unit with Cardiogenic Shock in Terms of Etiology, Treatment and Long-Term Prognosis
Pediatrik Yoğun Bakım Ünitesine Kardiyojenik Şok Tablosunda Başvuran Olguların Etiyoloji, Tedavi ve Uzun Dönem Prognoz Açısından Retrospektif Değerlendirilmesi
Turkiye Klinikleri J Med Sci. 2022;42(2):69-78
doi: 10.5336/medsci.2022-89203
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: Cardiogenic shock is acute circulation failure emerging with a linkage to disrupted myocardial contraction. The aim of this study is to identify the underlying etiology, assess the treatment methods, and the longterm prognoses of survivors among the patients admitted to intensive care with cardiogenic shock for the first time and without a previous heart disease history. Material and Methods: This study included patients admitted to the intensive care unit in our hospital for the first time with cardiogenic shock from March 2016 to March 2020. The age interval was 1 month to 18 years. The demographic, clinical, laboratory, and radiological findings for patients were recorded. All patients were evaluated with echocardiography at admission and 12 months after discharge. Results: Of the 24 patients included in this study, 50% were girls (n=12). Nineteen (79.1%) of the 24 patients had acute myocarditis as the underlying cause. Three (12.5%) patients had hypocalcaemia linked to vitamin D deficiency, 1 (4.2%) patient had anomalous left coronary artery from the pulmonary artery syndrome, and 1 (4.2%) patient had cardiac tamponade linked to purulent pericarditis. In echocardiographic examinations performed at a 12-month interval, left ventricle ejection fraction increased from 32.45±9.26% to 49.18±15.53%, and left ventricle end-diastolic diameter Z score decreased from 5.65 (4.4) to 2.02 (4.76). Conclusion: With appropriate fluids, diuretic treatment, inotrope management, and extracorporeal support, the prognosis for these patients has clearly improved in recent years.
Keywords: Pediatric intensive care; cardiogenic shock; myocarditis; dilated cardiomyopathy
Objective: Cardiogenic shock is acute circulation failure emerging with a linkage to disrupted myocardial contraction. The aim of this study is to identify the underlying etiology, assess the treatment methods, and the longterm prognoses of survivors among the patients admitted to intensive care with cardiogenic shock for the first time and without a previous heart disease history. Material and Methods: This study included patients admitted to the intensive care unit in our hospital for the first time with cardiogenic shock from March 2016 to March 2020. The age interval was 1 month to 18 years. The demographic, clinical, laboratory, and radiological findings for patients were recorded. All patients were evaluated with echocardiography at admission and 12 months after discharge. Results: Of the 24 patients included in this study, 50% were girls (n=12). Nineteen (79.1%) of the 24 patients had acute myocarditis as the underlying cause. Three (12.5%) patients had hypocalcaemia linked to vitamin D deficiency, 1 (4.2%) patient had anomalous left coronary artery from the pulmonary artery syndrome, and 1 (4.2%) patient had cardiac tamponade linked to purulent pericarditis. In echocardiographic examinations performed at a 12-month interval, left ventricle ejection fraction increased from 32.45±9.26% to 49.18±15.53%, and left ventricle end-diastolic diameter Z score decreased from 5.65 (4.4) to 2.02 (4.76). Conclusion: With appropriate fluids, diuretic treatment, inotrope management, and extracorporeal support, the prognosis for these patients has clearly improved in recent years.
Keywords: Pediatric intensive care; cardiogenic shock; myocarditis; dilated cardiomyopathy
ÖZET
Amaç: Kardiyojenik şok, miyokardiyal kontraksiyonun bozulmasına bağlı akut dolaşım yetersizliğidir. Bu çalışmanın amacı, yoğun bakıma kardiyojenik şok kliniği ile ilk kez yatırılan ve bilinen kalp hastalığı olmayan hastalarda, altta yatan etiyolojiyi saptamak, uygulanan tedavi yöntemlerini ve yaşayan hastalarda uzun dönem prognozu değerlendirmektir. Gereç ve Yöntemler: Bu çalışmaya, Mart 2016-Mart 2020 tarihleri arasında kardiyojenik şok kliniği ile ilk kez hastanemiz yoğun bakım ünitesine yatırılan hastalar dâhil edildi. Yaş aralığı 1 ay-18 yaş idi. Hastaların demografik, klinik, laboratuvar ve radyolojik bulguları kaydedildi. Tüm hastalar, yatışta ve taburcu olduktan 12 ay sonra ekokardiyografi ile değerlendirildi. Bulgular: Çalışmaya 24 hasta dâhil edildi, %50'si kız (n=12) idi. Yirmi dört hastanın 19'unda (%79,1) altta yatan neden akut miyokardit, 3 (%12,5) hastada D vitamini eksikliğine bağlı hipokalsemi, 1 (%4,2) hastada sol koroner arterin pulmoner arterden çıkış anomalisi, 1 (4,2%) hastada pürülan perikardite bağlı kardiyak tamponad idi. On iki ay arayla yapılan ekokardiyografik incelemelerde sol ventrikül ejeksiyon fraksiyonunun %32,45±9,26'dan %49,18±15,53'e yükseldiği; sol ventrikül diyastol sonu çapı Z skorunun 5,65'ten (4,4) 2,02'ye (4,76) düştüğü bulundu. Sonuç: Uygun sıvı, uygun diüretik tedavi, doğru inotrop yönetimi ve uygun ekstrakorporeal destek tedavileri ile son yıllarda bu hastaların prognozlarında belirgin düzelme izlenmektedir.
Anahtar Kelimeler: Çocuk yoğun bakım; kardiyojenik şok; miyokardit; dilate kardiyomiyopati
Amaç: Kardiyojenik şok, miyokardiyal kontraksiyonun bozulmasına bağlı akut dolaşım yetersizliğidir. Bu çalışmanın amacı, yoğun bakıma kardiyojenik şok kliniği ile ilk kez yatırılan ve bilinen kalp hastalığı olmayan hastalarda, altta yatan etiyolojiyi saptamak, uygulanan tedavi yöntemlerini ve yaşayan hastalarda uzun dönem prognozu değerlendirmektir. Gereç ve Yöntemler: Bu çalışmaya, Mart 2016-Mart 2020 tarihleri arasında kardiyojenik şok kliniği ile ilk kez hastanemiz yoğun bakım ünitesine yatırılan hastalar dâhil edildi. Yaş aralığı 1 ay-18 yaş idi. Hastaların demografik, klinik, laboratuvar ve radyolojik bulguları kaydedildi. Tüm hastalar, yatışta ve taburcu olduktan 12 ay sonra ekokardiyografi ile değerlendirildi. Bulgular: Çalışmaya 24 hasta dâhil edildi, %50'si kız (n=12) idi. Yirmi dört hastanın 19'unda (%79,1) altta yatan neden akut miyokardit, 3 (%12,5) hastada D vitamini eksikliğine bağlı hipokalsemi, 1 (%4,2) hastada sol koroner arterin pulmoner arterden çıkış anomalisi, 1 (4,2%) hastada pürülan perikardite bağlı kardiyak tamponad idi. On iki ay arayla yapılan ekokardiyografik incelemelerde sol ventrikül ejeksiyon fraksiyonunun %32,45±9,26'dan %49,18±15,53'e yükseldiği; sol ventrikül diyastol sonu çapı Z skorunun 5,65'ten (4,4) 2,02'ye (4,76) düştüğü bulundu. Sonuç: Uygun sıvı, uygun diüretik tedavi, doğru inotrop yönetimi ve uygun ekstrakorporeal destek tedavileri ile son yıllarda bu hastaların prognozlarında belirgin düzelme izlenmektedir.
Anahtar Kelimeler: Çocuk yoğun bakım; kardiyojenik şok; miyokardit; dilate kardiyomiyopati
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