Diastolic Dysfunction in Children with Fluid Refractory Septic Shock

The presence of cardiac dysfunction in patients with septic shock has been described for decades. However, the true prevalence or ultimate effect of diastolic dysfunction has only been described in septic children in limited fashion. Sankar et al analyzed 56 children (all between three months and 17 years of age) with fluid refractory septic shock, before inotropes or mechanical ventilation were initiated. The primary objectives of this study were to determine the prevalence of diastolic dysfunction in children with fluid refractory septic shock and to determine if there was an association between diastolic dysfunction and mortality.

The authors demonstrated that diastolic dysfunction in children with fluid refractory septic shock is relatively common, similar to some adult findings. Interestingly, children with diastolic dysfunction and those with no cardiac dysfunction had higher mortality rates than those with systolic dysfunction (43%, 37% and 15%, respectively), though these differences were not statistically significant. In the wake of this study, questions still linger about the true prevalence of diastolic dysfunction in children with fluid refractory septic shock. Further studies are needed to confirm these findings.

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