1238: ASSOCIATION OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION WITH RESPIRATORY FAILURE IN PEDIATRIC SEPSIS

Abstract

Introduction: Left ventricular diastolic dysfunction (LVDD) is associated with longer mechanical ventilation and increased mortality in adults with sepsis. The significance of LVDD in pediatric sepsis is not well characterized. We prospectively evaluated the prevalence of LVDD in pediatric sepsis patients and hypothesized that LVDD is associated with development of respiratory failure (primary outcome), use of non-invasive positive pressure ventilation (NIPPV), vasopressor/inotrope requirement, PICU length of stay (LOS), and mortality (secondary outcomes). Methods: This is an interim analysis of a prospective study of pediatric patients with severe sepsis or septic shock in a quaternary non-cardiac PICU. Goal enrollment is 120 patients. Point-of-care cardiac ultrasound (POCUS) images were obtained for mitral inflow (E), atrial (A), early mitral annular motion septal and lateral (e’) velocities within 48 hours of sepsis onset by PICU providers. LVDD was defined as E/e’ >10 or E/A < 0.8 or >1.5. Respiratory failure was defined as PaO2:FiO2 ratio < 300 or SpO2:FiO2 ratio < 264 at 48-96 hours after sepsis onset. Fisher’s exact and Wilcoxon rank-sum tests were utilized to compare patients with and without LVDD. Results: 42 patients have been enrolled. Secondary cardiologist review of POCUS images deemed that 70% were of acceptable quality for inclusion, yielding 37 evaluable patients. 19 (51%) patients met LVDD criteria. Among patients with LVDD vs without LVDD, there was no difference in age (8.2 vs 6.5 years; p=0.58), admission risk of mortality (PIM2 %ROM median 4.1, IQR [3.1,5.6] vs 4.7 [1.3,5.4]; p=0.82), or vasopressor support at the time of study (84% vs 83%; p=1). LVDD was associated with subsequent respiratory failure (47% with LVDD vs 11% without LVDD; p=0.03), however not with NIPPV use (53% vs 33%; p=0.33), vasopressor/inotrope requirement (84% vs 94%; p=0.34), PICU LOS (5 [3,9.5] vs 4.5 [3,8.3] days; p=0.52) or mortality (5% vs 0%; p=1). Conclusions: Half of children with sepsis exhibited LVDD on POCUS evaluation. This interim analysis suggests that LVDD may be associated with the development of hypoxemic respiratory failure but not NIPPV use, vasopressor/inotrope requirement, PICU LOS, or mortality.