• Pui Yin Florence Ip, Uvaraj Periasamy, Steven J Staffa, David Zurakowski, and David B Kantor.
• Department of Medicine, Boston Children's Hospital, Boston, MA.
• Pediatr Crit Care Me. 2024 Aug 1; 25 (8): 689698689-698.

ObjectivesTo evaluate management changes and outcomes in critically ill children after formal echocardiography.DesignRetrospective cohort study between January 1, 2011, and December 31, 2020.SettingTertiary care children's hospital.PatientsPatients from 1 to 18 years who had formal echocardiography within 72 hours of ICU admission and who were intubated and on vasoactive infusions at the time of the study. Patients were stratified into two cardiac function groups: 1) near-normal cardiac function and 2) depressed cardiac function.MethodsClinical variables were abstracted from the electronic medical record and placed in time sequence relative to echocardiography. Vasoactive and fluid management strategies in place before echocardiography were associated with markers of tissue perfusion and volume overload. Management changes after echocardiography were characterized and associated with outcomes.InterventionsNone.Measurements And Main ResultsAmong patients eventually found to have depressed cardiac function, the use of vasoconstrictors was associated with worse lactate clearance and oxygen extraction ratio. Use of vasoconstrictors in this cohort was also associated with a more liberal fluid management strategy, evidence of increased lung water, and a worse Sp o2 /F io2 . An echocardiogram demonstrated depressed cardiac function was likely to be followed by management changes that favored inotropes and more conservative fluid administration. Patients with depressed cardiac function who were switched to inotropes were more likely to be extubated and to wean off vasoactive support compared with those patients who remained on vasoconstrictors.ConclusionsAmong patients with depressed cardiac function, alterations in management strategy after echocardiography are associated with shortened duration of intensive care interventions.Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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