Çocuklarda Kardiyojenik Şoka Güncel Yaklaşım

Yıl 2020, Cilt: 8 Sayı: 1, 28 - 32, 30.04.2020

Çağlasu Esatoğlu Ahmet Sert

Öz

Miyokardiyal kasılmanın bozulmasına bağlı gelisen bir akut dolaşım yetmezliği olarak tanımlanan kardiyojenik şok; yetişkinlerden daha sık iken çocuklarda çok nadir görülmektedir. Şokun erken belirtilerini tanıma, yönetim prensipleri ve tedavi hedefleri, hemodinamik ve biyolojik değişkenleri izleme ve takip etme ve dolaşım desteği kardiyojenik şoklu çocuklarda yapılacak uygulamaların ana basamaklarıdır. Kardiyojenik şoklu çocuklarda tedavinin temel prensibi primer olarak klinik ve ekokardiyografik değerlendirmeye dayalıdır. Kardiyojenik şok nedeniyle yatırılarak tedavi edilen hastalar mutlaka çocuk yoğun bakım şartlarında uzman ekip kontrolünde takip edilmelidir. Bu ekipte pediatrik kardiyoloji, pediatrik acil, kalp damar cerrahisi ve radyoloji branşları yer almaktadır. Bu derleme ile güncel pediatrik kardiyojenik şoka yaklaşım gözden geçirilmesi amaçlanmıştır.

Anahtar Kelimeler

kardiojenik şok, çocukluk çağı, tedavi

Current Approach to Cardiogenic Shock in Children

Öz

Cardiogenic shock which corresponds to an acute state of circulatory failure due to impairment of myocardial contractility is a very rare disease in children, even more than in adults. Recognition of early signs of shock, management principles and therapeutic goals, monitoring hemodynamic and biological variables, circulatory support are the main steps of applications to be made in children with cardiogenic shock. Hospitalized children with cardiogenic shock should be followed in an intensive care unit by an expert team. Pediatric cardiology, pediatric emergency, cardiac surgery and radiology departments should be included in this team. The aim of this study is to review current approch to pediatric cardiogenic shock.

Anahtar Kelimeler

Cardiogenic shock, childhood, therapy

Kaynakça

• KAYNAKLAR: 1. Levy B, Bastien O, Karim B, Cariou A, Chouihed T, Combes A, et al. Erratum to: experts’ recommendations for the management of adult patients with cardiogenic shock. Ann Intensive Care. 2015;5(1):26. doi: 10.1186/s13613-015-0063-y. 2. Fisher JD, Nelson DG, Beyersdorf H, Satkowiak LJ. Clinical spectrum of shock in the pediatric emergency department. Pediatr Emerg Care. 2010;26(9):622–625. doi: 10.1097/PEC.0b013e3181ef04b9 3. Singh D, Chopra A, Pooni PA, Bhatia RC. A clinical profile of shock in children in Punjab, India. Indian Pediatr. 2006;43(7):619–623. 4. Rossano JW, Kim JJ, Decker JA, Price JF, Zafar F, Graves DE, 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(6):459–470. doi: 10.1016/j.cardfail.2012.03.001. 5. Massin MM, Astadicko I, Dessy H. Epidemiology of heart failure in a tertiary pediatric center. Clin Cardiol. 2008;31(8):388–391. doi: 10.1002/clc.20262. 6. Saji T, Matsuura H, Hasegawa K, Nishikawa T, Yamamoto E, Ohki H, et al. Comparison of the clinical presentation, treatment, and outcome of fulminant and acute myocarditis in children. Circ J. 2012;76(5):1222–1228. doi: 10.1253/circj.CJ-11-1032. 7. Sommers C, Nagel BH, Neudorf U, Schmaltz AA. Congestive heart failure in childhood. An epidemiologic study. Herz. 2005;30(7):652–662. doi: 10.1007/s00059-005-2596-6. 8. Biarent D, Bingham R, Eich C, Lopez-Herce J, Maconochie I, Rodriguez-Nunez A, et al. European resuscitation council guidelines for resuscitation 2010 section 6. Paediatric life support. Resuscitation. 2010;81(10):1364–1388. doi: 10.1016/j.resuscitation.2010.08.012 9. Olivier Brissaud,Astrid Botte, Gilles Cambonie, Stéphane Dauger, Laure de Saint Blanquat, Philippe Durand,Véronique Gournay, Elodie Guillet, Daniela Laux, Francis Leclerc, Philippe Mauriat, Thierry Boulain, Khaldoun Kuteifan. Experts’ recommendations for the management of cardiogenic shock in children. 10. Chaturvedi V, Saxena A. Heart failure in children: clinical aspect and management. Indian J Pediatr. 2009;76(2):195–205. doi: 10.1007/s12098-009-0050-0. 11. Kantor PF, Lougheed J, Dancea A, McGillion M, Barbosa N, Chan C, et al. Presentation, diagnosis, and medical management of heart failure in children: canadian cardiovascular society guidelines. Can J Cardiol. 2013;29(12):1535–1552. doi: 10.1016/j.cjca.2013.08.008. 12. Wilkinson JD, Landy DC, Colan SD, Towbin JA, Sleeper LA, Orav EJ, et al. The pediatric cardiomyopathy registry and heart failure: key results from the first 15 years. Heart Fail Clin. 2010;6(4):401–13, vii. 13. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36(1):296–327. doi: 10.1097/01.CCM.0000298158.12101.41. 14. Duke TD, Butt W, South M. Predictors of mortality and multiple organ failure in children with sepsis. Intensive Care Med. 1997;23(6):684–692. doi: 10.1007/s001340050394. 15. Hatherill M, McIntyre AG, Wattie M, Murdoch IA. Early hyperlactataemia in critically ill children. Intensive Care Med. 2000;26(3):314–318. doi: 10.1007/s001340051155. 16. Halley GC, Tibby S. Hemodynamic monitoring. In: Nichols DG, editor. Roger's textbook of pediatric intensive care. Philadelphia: Wolters Kluwer/Lippincott, Williams & Wilkins; 2008. pp. 1039–1063. 17. Babuin L, Jaffe AS. Troponin: the biomarker of choice for the detection of cardiac injury. CMAJ. 2005;173(10):1191–1202. doi: 10.1503/cmaj/051291. 18. Checchia PA, Moynihan JA, Brown L. Cardiac troponin I as a predictor of mortality for pediatric submersion injuries requiring out-of-hospital cardiopulmonary resuscitation. Pediatr Emerg Care. 2006;22(4):222–225. doi: 10.1097/01.pec.0000208504.21625.f5. 19. Cohen S, Springer C, Avital A, Perles Z, Rein AJ, Argaman Z, et al. Amino-terminal pro-brain-type natriuretic peptide: heart or lung disease in pediatric respiratory distress? Pediatrics. 2005;115(5):1347–1350. doi: 10.1542/peds.2004-1429. 20. Kantor PF, Rusconi P, Lipshultz S, Mital S, Wilkinson JD, Burch M. Current applications and future needs for biomarkers in pediatric cardiomyopathy and heart failure: summary from the second international conference on pediatric cardiomyopathy. Prog Pediatr Cardiol. 2011;32(1):11–14. doi: 10.1016/j.ppedcard.2011.06.003. 21. Sugimoto M, Manabe H, Nakau K, Furuya A, Okushima K, Fujiyasu H, et al. The role of N-terminal pro-B-type natriuretic peptide in the diagnosis of congestive heart failure in children—correlation with the heart failure score and comparison with B-type natriuretic peptide. Circ J. 2010;74(5):998–1005. doi: 10.1253/circj.CJ-09-0535. 22. Gessler P, Knirsch W, Schmitt B, Rousson V, von Eckardstein A. Prognostic value of plasma N-terminal pro-brain natriuretic peptide in children with congenital heart defects and open-heart surgery. J Pediatr. 2006;148(3):372–376. doi: 10.1016/j.jpeds.2005.10.039. 23. Nir A, Lindinger A, Rauh M, Bar-Oz B, Laer S, Schwachtgen L, et al. NT-pro-B-type natriuretic peptide in infants and children: reference values based on combined data from four studies. Pediatr Cardiol. 2009;30(1):3–8. doi: 10.1007/s00246-008-9258-4. 24. Olivier Brissaud,Astrid Botte, Gilles Cambonie, Stéphane Dauger, Laure de Saint Blanquat, Philippe Durand,Véronique Gournay, Elodie Guillet, Daniela Laux, Francis Leclerc, Philippe Mauriat, Thierry Boulain, Khaldoun Kuteifan. Experts’ recommendations for the management of cardiogenic shock in children. 25. Biarent D, Bourdages M, Berner M, Miro J, Doesburg NH, Toledano B. Heart failure in infants and children: etiology, pathophysiology, and diagnosis of heart failure. In: Lacroix DG, Gauthier M, Hubert P, Leclerc F, Gaudreault P, editors. Urgences et soins intensifs pediatriques. Masson: Edition du Sainte Justine et Elsevier; 2007. pp. 187–210. 26. Kantor PF, Mertens LL. Clinical practice: heart failure in children. Part II: current maintenance therapy and new therapeutic approaches. Eur J Pediatr. 2010;169(4):403–410. doi: 10.1007/s00431-009-1133-7. 27. Kim JJ, Rossano JW, Nelson DP, Price JF, Dreyer WJ. Heart failure in infants and children: etiology, pathophysiology, and diagnosis of heart failure. In: Nichols DG, editor. Roger's textbook of pediatric intensive care. Philadelphia: Wolters Kluwer/Lippincott, Williams & Wilkins; 2008. pp. 1064–1074. 28. Zingarelli B. Shock and reperfusion. In: Nichols DG, editor. Roger's textbook of pediatric intensive care. Philadelphia: Wolters Kluwer/Lippincott, Williams & Wilkins; 2008. pp. 1039–1063. 29. Olivier Brissaud,Astrid Botte, Gilles Cambonie, Stéphane Dauger, Laure de Saint Blanquat, Philippe Durand,Véronique Gournay, Elodie Guillet, Daniela Laux, Francis Leclerc, Philippe Mauriat, Thierry Boulain, Khaldoun Kuteifan. Experts’ recommendations for the management of cardiogenic shock in children. 30. Chaturvedi V, Saxena A. Heart failure in children: clinical aspect and management. Indian J Pediatr. 2009;76(2):195–205. doi: 10.1007/s12098-009-0050-0. 31. Kantor PF, Lougheed J, Dancea A, McGillion M, Barbosa N, Chan C, et al. Presentation, diagnosis, and medical management of heart failure in children: canadian cardiovascular society guidelines. Can J Cardiol. 2013;29(12):1535–1552. doi: 10.1016/j.cjca.2013.08.008. 32. James N, Smith M. Treatment of heart failure in children. Curr Paediatr. 2005;15(7):539–548. doi: 10.1016/j.cupe.2005.08.003. 33. Rosenthal D, Chrisant MR, Edens E, Mahony L, Canter C, Colan S, et al. International Society for Heart and Lung Transplantation: practice guidelines for management of heart failure in children. J Heart Lung Transplant. 2004;23(12):1313–1333. doi: 10.1016/j.healun.2004.03.018. 34. Sandroni C, Nolan J. ERC 2010 guidelines for adult and pediatric resuscitation: summary of major changes. Minerva Anestesiol. 2011;77(2):220–226. 35. Patterson MD, Boenning DA, Klein BL, Fuchs S, Smith KM, Hegenbarth MA, et al. The use of high-dose epinephrine for patients with out-of-hospital cardiopulmonary arrest refractory to prehospital interventions. Pediatr Emerg Care. 2005;21(4):227–237. doi: 10.1097/01.pec.0000161468.12218.02. 36. Perondi MB, Reis AG, Paiva EF, Nadkarni VM, Berg RA. A comparison of high-dose and standard-dose epinephrine in children with cardiac arrest. N Engl J Med. 2004;350(17):1722–1730. doi: 10.1056/NEJMoa032440. 37. Myburgh J, Finfer S. Causes of death after fluid bolus resuscitation: new insights from FEAST. BMC Med. 2013;11:67. 38. Olivier Brissaud,Astrid Botte, Gilles Cambonie, Stéphane Dauger, Laure de Saint Blanquat, Philippe Durand,Véronique Gournay, Elodie Guillet, Daniela Laux, Francis Leclerc, Philippe Mauriat, Thierry Boulain, Khaldoun Kuteifan. Experts’ recommendations for the management of cardiogenic shock in children. 39. Strigl S, Beroukhim R, Valente AM, Annese D, Harrington JS, Geva T, et al. Feasibility of dobutamine stress cardiovascular magnetic resonance imaging in children. J Magn Reson Imaging. 2009;29(2):313–319. doi: 10.1002/jmri.21639. 40. Namachivayam P, Crossland DS, Butt WW, Shekerdemian LS. Early experience with Levosimendan in children with ventricular dysfunction. Pediatr Crit Care Med. 2006;7(5):445–448. doi: 10.1097/01.PCC.0000235251.14491.75. 41. Levy B, Perez P, Perny J, Thivilier C, Gerard A. Comparison of norepinephrine-dobutamine to epinephrine for hemodynamics, lactate metabolism, and organ function variables in cardiogenic shock. A prospective, randomized pilot study. Crit Care Med. 2011;39(3):450–455. doi: 10.1097/CCM.0b013e3181ffe0eb. 42. Olivier Brissaud,Astrid Botte, Gilles Cambonie, Stéphane Dauger, Laure de Saint Blanquat, Philippe Durand,Véronique Gournay, Elodie Guillet, Daniela Laux, Francis Leclerc, Philippe Mauriat, Thierry Boulain, Khaldoun Kuteifan. Experts’ recommendations for the management of cardiogenic shock in children. 43. Gupta P, Kuperstock JE, Hashmi S, Arnolde V, Gossett JM, Prodhan P, et al. Efficacy and predictors of success of noninvasive ventilation for prevention of extubation failure in critically ill children with heart disease. Pediatr Cardiol. 2013;34(4):964–977. doi: 10.1007/s00246-012-0590-3. 44. Odena MP, Marimbaldo IP, Matute SS, Argallo MB, Rico AP. Aplicacion de ventilacion no invasiva en pacientes postoperados cardiacos. Estudio retrospectivo. An Pediatr (Barc). 2009;71(1):13–19. doi: 10.1016/j.anpedi.2009.03.014. 45. Faruk Cingöz, Harun Tatar. Çocuklarda ekstrakorporeal membran oksijenatör kullanımı Gülhane Askeri Tıp Akademisi, Kalp ve Damar Cerrahisi Anabilim Dalı, Ankara