Heart Rate and Blood Pressure Centile Curves and Distributions by Age of Hospitalized Critically Ill Children.

Danny Eytan,Andrew J Goodwin,Anne-Marie Guerguerian,Robert Greer,Peter C Laussen

doi:10.3389/fped.2017.00052

Abstract

Heart rate (HR) and blood pressure (BP) form the basis for monitoring the physiological state of patients. Although norms have been published for healthy and hospitalized children, little is known about their distributions in critically ill children. The objective of this study was to report the distributions of these basic physiological variables in hospitalized critically ill children. Continuous data from bedside monitors were collected and stored at 5-s intervals from 3,677 subjects aged 0–18 years admitted over a period of 30 months to the pediatric and cardiac intensive care units at a large quaternary children’s hospital. Approximately 1.13 billion values served to estimate age-specific distributions for these two basic physiological variables: HR and intra-arterial BP. Centile curves were derived from the sample distributions and compared to common reference ranges. Properties such as kurtosis and skewness of these distributions are described. In comparison to previously published reference ranges, we show that children in these settings exhibit markedly higher HRs than their healthy counterparts or children hospitalized on in-patient wards. We also compared commonly used published estimates of hypotension in children (e.g., the PALS guidelines) to the values we derived from critically ill children. This is a first study reporting the distributions of basic physiological variables in children in the pediatric intensive care settings, and the percentiles derived may serve as useful references for bedside clinicians and clinical trials.

Highlights

Variables such as heart rate (HR), respiratory rate, and blood pressure (BP) form the basis for evaluating and monitoring the physiological state of patients
We focus on Heart rate (HR) and invasively recorded arterial BP as these are basic physiological variables used for clinical assessment, predictions, and alarm settings, and they are less prone to be influenced by artifacts compared to variables such as central venous pressure, which may be skewed due to additional infusions or respiratory rate as many of these patients were ventilated throughout parts of their hospitalization
We report the development of centile curves for HR and intraarterial BP among children hospitalized in the critical care setting

Summary

Introduction

Variables such as heart rate (HR), respiratory rate, and blood pressure (BP) form the basis for evaluating and monitoring the physiological state of patients. These variables may be recorded continuously and serve for detecting deterioration, modifying interventions, and assessing response to treatments in sick children. Critical care clinicians set target ranges manually according to the assessed clinical state or resort to using published norms derived from the studies of healthy children, at rest, in a sitting position or ambulating, using devices and measurement methods intended to be used in out-patient. Norms generated from estimates obtained in healthy subjects were most often not cross-validated in the decubitus position, across the broad physiologic and disease conditions experienced during childhood critical illness or for variables recorded using invasive monitoring devices. For BP, the purpose of the majority of the studies in healthy children was to develop normative data to operationalize the diagnosis of hypertension and not to generate thresholds to define hypotension

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