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

01 Jan 2022
Alexander PMA, Checchia PA, Ryerson LM, Bohn D, Eckerle M, Gaies M, Laussen P, Jeffries H, Thiagarajan RR, Shekerdemian L, Bembea MM, Zimmerman JJ, Kissoon N, Pediatric Organ Dysfunction Information Update Mandate (PODIUM) Collaborative

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.