P0356 / #2096: LEFT VENTRICULAR HYPOKINESIA (LVH) IN CHILDREN WITH ACUTE CIRCULATORY FAILURE (ACF): EVALUATION AND MANAGEMENT IN PEDIATRIC INTENSIVE CARE UNIT (PICU).

Abstract

Aims & Objectives: Fluid loading remains the first treatment step resuscitation for most children with acute circulatory failure (ACF) associated or not with vasopressor drugs, but the use of an inotrope to supply myocardial dysfunction guided by transthoracic echocardiography (TTE) evaluation. The aim our study is to describe the role of TTE evaluation of the LV function to detect the LVH and to guide hemodynamic management. Methods: In this prospective observational study conducted in our PICU from January 2012 to December 2017. The evaluation of the left ventricular ejection fraction (LVEF) and Cardiac index (CI), and right ventricular (RV) function with Tricuspid Annular Plane Systolic Excursion (TAPSE) in patients with ACF using TTE Results: We detected LVH in 27 patients with median age of 36 (2,5-180) months. Septic shock, and adrenergic myocarditis were the essentials etiologies. LV TTE evaluation at baseline and after treatment by inotrope showed: median LVEF [46,1±10,2 Vs 57,6±9,4%; p<0,0001] and median CI [3,40±1,14 Vs. 4,04± 1,23 l/min/m2, p<0,0001]. The evaluation of RV function showed median TAPSE at baseline and after treatment (15,7±2,99 Vs,16,7±3,4 mm; p=0,033). Patients receive dobutamine dose (4,11±4,97 Vs. 7,29±4,12 μg/kg/min, p<0,0001) and norepinephrine dose don’t change during increasing dobutamine dose 1,85±2,59 μg/kg/min to maintain MAP 73,6±16,1 mmHg Conclusions: TTE has an important role in the management of LVH in PICU at bedside. It became an inevitable tool allows detection of myocardial dysfunction.